Functional Communication Training for Problem Behavior 9781462530212

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Functional Communication Training for Problem Behavior

Functional Communication Training   for  Problem Behavior Joe Reichle David P. Wacker

THE GUILFORD PRESS New York  London

Copyright © 2017 The Guilford Press A Division of Guilford Publications, Inc. 370 Seventh Avenue, Suite 1200, New York, NY 10001 www.guilford.com All rights reserved No part of this book may be reproduced, translated, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the publisher. Printed in the United States of America This book is printed on acid-­free paper. Last digit is print number: 9 8 7 6 5 4 3 2 1 The authors have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards of practice that are accepted at the time of publication. However, in view of the possibility of human error or changes in behavioral, mental health, or medical sciences, neither the authors, nor the editor and publisher, nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they are not responsible for any errors or omissions or the results obtained from the use of such information. Readers are encouraged to confirm the information contained in this book with other sources. Library of Congress Cataloging-­in-­P ublication Data is available from the publisher. ISBN 978-­1-­4625-­3021-­2 (hardcover)

To Patti, Chris, and Megan And also to my current and former doctoral students, who, as it turns out, gave me a great education —J. R.

To my dad, James E. Wacker —D. P. W.

About the Authors

Joe Reichle, PhD, is Professor of Speech–Language–Hearing Sciences and Research Director of the Leadership and Education in Neurodevelopmental Disabilities Training Program at the University of Minnesota. A Fellow of the American Speech–Language–Hearing Association, Dr. Reichle has expertise in augmentative communication, communication intervention for persons with significant developmental disabilities, and positive approaches to meet the needs of persons who engage in challenging behavior. He has published over 140 articles, chapters, and books, and served as an associate editor of the Journal of Speech, Language, and Hearing Research and Language, Speech, and Hearing Services in Schools. He has extensive experience delivering technical assistance to public schools and group homes. David P. Wacker, PhD, is Professor Emeritus of Pediatric Psychology at The University of Iowa, where he directed biobehavioral outpatient services for children and adults with developmental disabilities who display severe problem behavior, such as self-injury. A Fellow of the Association for Behavior Analysis International and the American Psychological Association, Dr. Wacker is a past editor of the Journal of Applied Behavior Analysis. His work has focused on training parents to implement functional communication training (FCT) in their homes or in community settings. His current research investigates how to best implement functional analysis and FCT in homes via the use of telehealth.

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Preface

Problem behavior represents an important challenge in enabling persons

with developmental disabilities to reach their full potential. For years, problem behavior was viewed as actions produced by an individual that should be suppressed. However, an overwhelming consensus has emerged over the past 40 years that much of the problem behavior produced by individuals with developmental disabilities is maintained by social consequences such as escaping aversive events or obtaining/maintaining access to objects, actions, and/or the attention of others. One viable intervention strategy is to teach learners a socially acceptable communicative alternative to the problem behavior that is maintained by those social consequences. We have spent much of our careers trying to determine how best to make this happen. Equally important, however, is the realization that just as socially acceptable communication can be empowering, it must be used in moderation. For example, while one can politely refuse asparagus, one cannot refuse seizure control medication. Consequently, it “takes a village” of intervention and support strategies—well beyond teaching alternative communication skills—to maintain a balance between communicative empowerment and self-­regulation. Even though this book deals almost exclusively with intervention, we know that linking the “function” of problem behavior to a closely targeted intervention is crucial in providing behavioral support. Although there a number of excellent resources that address the functional assessment of problem behavior, substantially fewer resources are available that address the procedural aspects of functional communication training (FCT) and related intervention/support strategies. In this volume, we have accumulated what we believe to be sound advice in implementing

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Preface

socially acceptable communicative behavior that serves as an alternative to an individual’s problem behavior. We also offer descriptions and examples of a variety of strategies that, when considered collectively, can provide assistance in designing a comprehensive support plan. Throughout the book, we use case examples (indicated by gray shading) to illustrate points that we make. We also acknowledge that the strategies we suggest are by no means the only way to intervene. The following is a brief overview of each chapter in this book. Chapter 1 provides an introduction to FCT. It describes the importance of determining the function(s) or purpose(s) served by problem behavior. Once this is accomplished, the interventionist is in a position to select a communicative alternative that closely matches the function served by problem behavior. This match is critical if the recipient of the intervention is to choose to use the new alternative rather than problem behavior to obtain the outcome that he or she seeks. Chapter 2 describes the selection of a communicative alternative to be taught. In doing so, we identify potential disciplinary differences in the interpretation of the term communicative function. We describe the nature of these differences by emphasizing the importance of a team approach and understanding each discipline’s approach to understanding why an individual attempts to influence the behavior of others. We also consider the selection of a communicative mode and the specificity of symbols that are selected for communicative alternatives to problem behavior. We emphasize the importance of considering the use of multiple communicative modes in designing FCT. Chapter 3 offers an integrative model to establish communicative alternatives and enhance self-­regulatory skills. This chapter introduces the importance of teaching an individual to use communicative behavior conditionally, that is, to understand when it is appropriate to use a newly taught communicative behavior. For example, an individual should request assistance when he or she cannot independently complete an activity, but refrain from using an assistance request when he or she can act independently. Using communicative behavior conditionally requires that the individual receive intervention that best maximizes appropriate generalized use while minimizing inappropriate use of a new communicative alternative. We identify general case instruction as a strategy that can provide assistance with learners who struggle with appropriate conditional use. In describing the importance of the conditional use of communicative behavior, we explain that for many individuals (e.g., persons who experience impulsivity), it can be difficult to strike a balance between empowerment and self-­regulation of their actions. We emphasize the importance of incorporating support strategies to enhance self-­regulatory skills during communication training. Because interventionists often use strategies that are consequence based, we

Preface xi

also provide a range of strategies, including antecedent-­focused interventions that can be implemented prior to an episode of problem behavior and consequence-­based interventions that can be implemented after the emission of problem behavior as well as after the emission of desirable behavior. Each group of strategies is often paired with FCT. Chapter 4 provides an elaboration of a number of different evidence-­ based antecedent-­focused intervention strategies. We describe each and provide examples of how these interventions can be utilized in applied settings and often combined with FCT. Chapters 5, 6, and 7 each address teaching communicative alternatives focused on problem behavior that is maintained by escape. Taken collectively, these chapters emphasize the importance of identifying the function that maintains problem behavior as precisely as possible. Chapter 5 addresses teaching socially acceptable communicative protesting. We provide a brief review of protesting among typically developing children and the intervention evidence in teaching protesting. This is followed by intervention steps that include examples. Chapter 6 is organized similarly to Chapter 5: it describes the development of assistance requests and discusses the range of situations that support requests for assistance. Requesting assistance is interesting in that it can serve as an alternative to problem behavior maintained by negative reinforcement (e.g., from a difficult or nonpreferred task) or as access to positive reinforcement (e.g., a tangible item). For example, difficult work may continue contingent on a request that provides sufficient assistance. Alternatively, a child may be unsuccessfully attempting to unwrap a present until assistance is requested with the appropriate consequence. Chapter 7 addresses problem behavior maintained by escape resulting from activities that extend beyond the individual’s ability to tolerate engagement. A range of situations that support this intervention are described. Subsequently, examples of combining FCT with antecedent-­focused intervention strategies are discussed, accompanied by procedural steps and examples. Chapter 8 addresses problem behavior that is maintained by the attention of others. After describing the emergence of attention-­seeking communicative strategies that occur in typical development, we discuss unique problems that can be associated with attention-­maintained behavior. For example, the motivating operations underlying responding with escape-­ maintained behavior are often quite apparent as the learner reacts to the presence of specific demands or situations. In many of these situations, the care provider has actually planned and instigated the events. However, with attention-­maintained problem behavior, there is often a highly individualistic response to not receiving attention—­that is, some learners appear to be motivated to obtain constant attention, while others have different levels of desired attention. Additionally, some learners demand attention only

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Preface

when they see others in their vicinity receiving attention. Finally, a learner’s response to the range of forms that attention can take is often different and may be influenced by who is delivering the attention. For these reasons, designing interventions to address behavior maintained by attention can be challenging for an interventionist with limited experience. Consequently, this chapter identifies some of the challenges in designing and implementing intervention strategies to address attention-­maintained behavior. Chapter 9 covers functional communication aimed at addressing problem behavior maintained by tangibles. We begin by discussing the importance of determining learner preferences and describe a variety of evidence-­ based strategies designed to assess preferences. Subsequent to determining learner preferences, we provide a number of suggestions for implementing a program to teach learners to use socially appropriate communicative alternatives to access desired objects and events. We conclude with Chapter 10, which summarizes the components of an effective positive support plan for persons who engage in behavior that is emitted to influence others’ behavior.

Acknowledgments

Joe Reichle: I gratefully acknowledge my colleagues, especially Dr. Jeff ­Sigafoos and Dr. Quannah Parker-­McGowan, who read several early chapter drafts, and Dr. Mo Chen, whose input on problem behavior contributed to the preparation of Chapter 10. David P. Wacker: I gratefully acknowledge my colleagues, especially Wendy Berg, Jay Harding, Joel Ringdahl, Linda Cooper-­Brown, and Scott ­Lindgren, for their dedication to our clinical and research programs, and my graduate students, too numerous to name, for the inspiration to always do more and do better. Special thanks to Dr. Kelly Schieltz for her proofing of early versions of the chapters and for creating the figures in Chapter 1, and to Katie Wacker for over 40 years of support.

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Contents

 1. Introduction to Functional Communication Training 1 FCT as a Differential Reinforcement Procedure  1 Identifying the Reinforcers for a Communicative Response  2 Functional Analysis  9

 2. The Selection of Communicative Function(s) to Teach 13 and How They Are Expressed What Events Lead to the Learner’s Overt Attempts to Socially Influence Others?  14 Identifying Specific Types of Functional Communicative Acts That Can Be Produced by Individuals Who Engage in Problem Behavior  16 Behavior Regulation  17 Joint Attention  17 Social Interaction  17

Considering the Relationship between Social Functions of Problem Behavior and Communicative Intents Discussed by Speech and Language Pathologists  17 Why Is It Important to Exactly Match Communicative Intents to Be Taught with Social Functions Derived from a Functional Assessment?  19 Selecting the Most Efficient Representation for a Particular Communicative Act  21 Identifying a Continuum of Symbol Specificity  22 Considering Possible Variables That Influence Choices Regarding Symbol Specificity  22

Identifying the Specific Communicative Means to Be Taught  23 xv

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Contents

 3. An Integrative Model to Establish Communicative Alternatives 28 and Enhance Self‑Regulatory Skills Self‑Regulation 30 Empowerment and Self‑Efficacy  31 Classes of Intervention Strategies That Must Be Jointly Considered in Addressing a Balance between Self‑Regulation and Empowerment  32 Antecedent‑Focused Intervention Strategies  33 Communicative Alternatives to Problem Behavior  36 Consequence‑Related Intervention Strategies  39 Reinforcement for Desired Behavior  41

An Integrated Implementation of Multicomponent Intervention for Problem Behavior That Includes Antecedent‑Focused, Communicative Alternative, and Consequence‑Based Intervention Components  46 The Role of General Case Logic in Implementing a Comprehensive Behavior Support Program  47 Examples of Establishing Conditional Use of Newly Established Behavior  49

Summary 50

 4. Examples of Antecedent‑Focused Intervention Strategies 51 Implementing an Antecedent‑Focused Intervention to Address Undesired Generalization (Socially Unacceptable Overgeneralized Use of a Communicative Alternative)  53 TFD in the Delivery of Reinforcement  54 Identifying Components of a TFD Procedure  55 Implementing a TFD Procedure with Behavior Maintained by Escape  56 Delayed Reinforcement  61 Prespecifying a Competing Schedule of Reinforcement to Moderate Overuse of a Communicative Alternative  62 Graphic Organizational Aids (Schedules)  64 Introducing Learner Choices in the Arrangement of Scheduled Activities  68

A Brief Summary of Prompting Strategies  81 Setting‑Event Interventions  84 Differentiating between Setting Events and MOs  85 Building Rapport as an Example of a Setting‑Event Support Strategy  89

Summary 91

 5. Teaching Communicative Protesting as an Alternative 92 to Avoidance‑Maintained Problem Behavior with Quannah Parker-­McGowan and Jeff Sigafoos What Is Communicative Protesting?  93 The Development of Early Protesting  96

Contents xvii Implications for Intervention from Natural Parent–Child Interactions  96 What Do We Know about Teaching Protesting?  99 A Guide to Teaching Protesting  101 Identify the Critical Event That Cues the Child to Engage in Escape‑ or Avoidance‑Motivated Problem Behavior  101 Identify Specific Activities That Can Serve as Teaching Examples  102 Identify a Socially Acceptable Communicative Means  105 Determine the Form and Consider the Efficiency of the Communicative Replacement  107 Identify a Provoking Event  108 Sequences of Intervention  109

Considering Spoken Language  112 Summary 113

 6. Teaching Requesting Assistance 114 The Development of Requests for Assistance  114 The Range of Situations That Support Requests for Assistance  115 The Importance of General Case Instruction in Teaching Assistance Requests  117 Generalization Limitations as a Challenge to Response Efficiency  117 Generalization of Assistance Requests across Communicative Functions  125

A Guide to Teaching Requesting Assistance  131 Getting Ready to Teach Requesting Assistance  131 Define the Range of Activities in Needing Assistance (Identify the MOs Related to Problem Behavior)  132 Identify Specific Activities That Can Serve as Positive and Negative Teaching Examples  133 Consider the Efficiency of the Communicative Alternative  135 Determine the Point in the Activity at Which the Learner Is Likely to Engage in Problem Behavior  135 Consider Ordering the Teaching Examples to Ensure Generalized and Conditional Use of Requests for Assistance  135 Sequences of Intervention  139 Instructional Procedures to Reduce Reliance on Requests for Assistance  141

How Will You Know If the Program Is Working?  142 What If the Learner Starts Requesting Assistance Earlier and Earlier in the Activity?  144 What If the Learner Continues to Request Assistance Even though He or She Has Learned to Complete Difficult Activities Independently?  146

Summary 148

 7. Requesting a Break 149 The Range of Situations That Support Requesting a Break  149 Ensuring Return from a Break  161

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Contents Positive Reinforcement for Extricating from a Break  161 Delayed Reinforcement of Successful Break Extrication  162 Ensuring a Sufficiently Brief Engagement in the Nonpreferred Activity as the Result of an Accurate and Valid Baseline  163 Reinforcing Return to Work with a Slower Resumption of Work (Easing Back into Work)  163

Ensuring Moderation in the Use of Requests for a Break  164 Competing Schedules of Reinforcement  164 Tolerance for Delay in the Delivery of Reinforcement  164

Competing Schedules of Reinforcement  165 A Brief Review of TFD as a Component of Teaching Break Requests  166 Investigations That Successfully Implemented TFD Combined with a Communicative Alternative for Problem Behavior  167

A Sample Guide to Teaching Requesting a Break  169 Getting Ready to Teach Requesting a Break  169 Identify Specific Activities That Can Serve as Teaching Examples  171 Determine the Communicative Form and Consider the Efficiency of the Communicative Replacement  171 Reinforce the Absence of Problem Behavior  171 Return to Work from Break Time  172 Select Reinforcer(s) That Can Be Obtained Only after a Successful Return to Work  173 Prompt the Break Request  173 Fade the Instructional Prompt  174 Gradually Make the Break Symbol Available Earlier in the Task and Introduce a TFD Cue  174 Increase the Degree of Participation in the Activity  175

How Will You Know If the Program Is Working?  175 Summary 177

 8. Teaching Communicative Requests as an Alternative 179 to Problem Behavior Maintained by Attention Communicative Requests for Attention and Tangibles and Their Early Development  181 FCT for Problem Behavior Maintained by Attention  181 Unique Problems Associated with Attention‑Maintained Problem Behavior  181 Problems with Punishment and Prevention  183 Considerations for Teaching Appropriate Communicative Requests for Attention MOs  189

Proficiency of the Child’s Use of Appropriate Communication  196 Relative Efficiency of Appropriate Communication  197 Consequences for Appropriate and Problem Behaviors  198 Summary 199

Contents xix

 9. Teaching Communicative Requests as an Alternative 201 to Problem Behavior Maintained by Tangibles FCT for Problem Behavior Maintained by Tangibles  202 Unique Problems Associated with Tangible‑Maintained Problem Behavior  202 Considerations for Teaching Appropriate Communicative Requests for Tangibles  204 Teaching an Initial Request for a Tangible Item or Activity  211

Summary 216

10. Describing Functional Communication Training 217 as a Component of an Effective Behavior Support Plan: What We Know and What We Still Need to Know The Importance of Addressing Problem Behavior Consistently, Comprehensively, and Early  217 The Importance of Determining What Maintains Problem Behavior  218 Assessing Motivating Operations  219 Linking Assessment to Intervention  220 The Necessary Components of a Behavior Support Plan  221 The Form of the Communicative Alternative Taught  222 Maintaining Newly Established Functional Communication  222 Generalizing Newly Established FCT  224 Identifying the Possible Interaction between Generalization and Conditional Use  225 Considering Multicomponent Intervention and Behavior Support Strategies  226 Addressing the Range of Collateral Gains Emanating from Successful FCT  227 Addressing Social Validity, Treatment Fidelity, and Contextual Fit  227 Implementing Interventions with Fidelity  229 Coordinating “High‑Dose” and “Low‑Dose” Interventions  231 Validating Instructional Procedures in Translational Settings  232 Identifying the Levels at Which Support Tactics to Prevent and Reduce Problem Behavior Are Implemented: In the End, It Takes a Village  232 Summary 234

Glossary 237 References 249 Index 267

Chapter 1

Introduction to Functional Communication Training

Carr and Durand (1985) provided the seminal article on functional com-

munication training (FCT). They showed how socially acceptable communicative acts, such as spoken requests for assistance or attention, can be taught to reduce the occurrence of problem behaviors such as aggression. Subsequently, numerous studies were published that replicated these results (e.g., Derby et al., 1997; Durand & Carr, 1991; Wacker, Berg, & Harding, et al., 1998) or evaluated the conditions under which FCT was most effective (e.g., Hagopian, Fisher, Sullivan, Acquisto, & LeBlanc, 1998; Horner & Day, 1991; Wacker et al., 1990). Over time, FCT became one of the most effective and popular treatments in the applied behavior analysis literature (Tiger, Hanley, & Bruzek, 2008), even for problem behaviors considered to be among the most severe. Studies on FCT continue to be published and focus on second-­generation issues such as how to best achieve conditional use (Reichle & McComas, 2004), generalization (Berg, Wacker, Harding, Ganzer, & Barretto, 2007), and maintenance (Volkert, Lerman, Call, & Trosclair-­Lassere, 2009; Wacker et al., 2011) with FCT.

FCT as a Differential Reinforcement Procedure Differential reinforcement of alternative behavior (DRA) is a treatment that involves the contingent presentation of reinforcement for a desired behavior and the withholding of reinforcement for problem behavior. In FCT, the desired behavior is appropriate communication, such as mands, 1

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that requests breaks, attention, or preferred items that are often referred to as communicative alternatives (Johnston, Reichle, Feeley, & Jones, 2012). FCT involves the contingent presentation of reinforcement for appropriate communication to reduce the occurrence of problem behavior. This seemingly straightforward treatment can be complex to implement. There are three core components of FCT that always need to be considered: (1) identifying the reinforcers to deliver for communicative alternatives, (2) identifying the specific communications acts to be taught (see Chapter 2), and (3) determining the specific intervention procedures and context for the desired communicative alternative (see chapters later in this book that address intervention strategies).

Identifying the Reinforcers for a Communicative Response It may be tempting to assume that FCT is effective because it increases an individual’s communicative repertoire, and that teaching someone one or more communicative responses will automatically lead to reductions in problem behavior. Increasing the number of words that the individual can emit independently is a necessary but not sufficient aspect of FCT. There are several important steps (summarized in Table 1.1) that increase the probability of a successful outcome. For example: 1. Identify reinforcers that currently maintain problem behavior. 2. Identify outcomes that will be reinforced routinely. 3. Reinforcement for problem behavior is discontinued or reduced substantially. 4. Teach the individual to communicate for the desired outcome independently using mands that are recognized by others, efficient to emit, and preferred by the individual. 5. Enrich the environment so that communication is reinforced on a dense schedule.1 Thus, we have to evaluate the reinforcers that maintain problem behavior and ensure that the communication responses taught during FCT result in the same reinforcers that previously maintained the problem behavior that the interventionist hopes to replace (Durand & Carr, 1985). Other 1 In

this book, we focus on socially maintained problem behavior—­that is, behavior reinforced by its effects on the environment, such as escaping demands or gaining attention. Although FCT can be used with nonsocial functions, such as automatic reinforcement (Steege, Wacker, Berg, Cigrand, & Cooper, 1989), that is beyond the scope of this book.

Introduction to FCT 3 TABLE 1.1.  Steps to Increase the Success of FCT Step

Reason

1. Identify reinforcers that currently maintain problem behavior.

Our goal is to replace problem behavior with a communicative alternative that requests the same reinforcement.

2. Identify outcomes that will be reinforced routinely.

Long-term maintenance requires ongoing and consistent reinforcement of the communicative alternatives.

3. Reinforcement for problem behavior is discontinued or reduced substantially.

Increasing the reinforcement for the communicative alternative relative to problem behavior increases the probability that the individual will choose to emit the communicative alternative.

4. Teach the individual to communicate for the desired outcome independently using mands that are recognized by others, efficient to emit, and preferred by the individual.

Independent communication permits the individual to request reinforcement when desired rather than when the interventionist schedules the delivery of reinforcement.

5. Enrich the environment so that communication is reinforced on a very dense schedule.

Communicative behavior will persist longer when challenged (e.g., when the individual has to wait for reinforcement) if it has been strengthened via high rates of reinforcement.

persons in the home, school, and community environments must recognize and respond to the communicative act produced (Durand & Carr, 1991) by providing the requested reinforcer (Durand, 1999; step 4). If socially acceptable communicative acts and problem behavior result in the same reinforcers, then increasing the reinforcement for communicative responses and decreasing or eliminating reinforcement for displays of problem behavior should reduce the occurrence of problem behavior and increase the maintenance of communicative behavior. Lieving, Hagopian, Long, and O’Connor (2004) provided a good demonstration of the hierarchical relation between appropriate communication and problem behavior. These authors provided reinforcement for only one form of behavior at a time, and showed that their participants displayed the behavior that was reinforced. When more than one response is maintained by the same reinforcers, this is referred to as a response class. Although several variables influence when a response is emitted (Mace & Roberts, 1993), an important factor in determining which specific behavior in the

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response class will be emitted first by the learner is the history of reinforcement. If learners are most often reinforced for emitting the communicative alternative, then, in the future, they are most likely to display that response before displaying other responses, including problem behavior. In most published reports of FCT, appropriate communication results in immediate reinforcement and problem behavior is placed on extinction (is ignored or does not produce reinforcement; Tiger et al., 2008). For example, if the individual requests attention by saying “Mom,” then mom provides immediate attention. Conversely, if the individual throws a toy or screams, mom ignores the response. If problem behavior is produced to obtain attention but is ignored and the individual has appropriate communication to display to obtain attention, then over time we would expect the individual to communicate appropriately more often than he or she displays problem behavior. We have frequently noted the following scenario in fast-food restaurants. A mom is holding a toddler who is upset. At some point, the toddler bites the mom or displays some other form of problem behavior. The mom quickly puts the child down (or leaves the restaurant) and says something like, “Don’t do that again. Use your words.” For typically developing children with typical language development, FCT is a common procedure used by parents and is initiated very early in the child’s development. The difference, of course, is that typically developing children already have relatively large vocabularies and thus need only to be reminded (or prompted) to use their words. When a child does not “have the words,” parents or care providers often “guess” and subsequently provide what they think the child wants. If they guess correctly, the child receives what he or she wants (positive reinforcement) and the parent or care provider also receives reinforcement in the form of escape from a very upset child (negative reinforcement). Being told to simply ignore the problem behavior is difficult for the parent for two reasons. First, the parent is disturbed that the child is so upset and cannot communicate. It can seem cruel to ignore their child. Second, it can be difficult not to stop a situation that bothers us and others around us because of negative reinforcement. Providing a communicative alternative gives the parents something proactive to do (e.g., guiding the child to hand the clerk a word card) and makes it easier for parents not to reinforce problem behavior. A main reason to place problem behavior on extinction during FCT is to teach the individual that problem behavior no longer “works” to obtain reinforcement. We want not only to reduce problem behavior but also, to the extent possible, suppress its future occurrence. Putting problem behavior on extinction weakens its occurrence over time relative to appropriate communication, which continues to be reinforced. Wacker et

Introduction to FCT 5

al. (2011) conceptualized this situation as increasing the strength of appropriate communication so that when individuals are later provided with a choice to produce problem behavior or appropriate behavior, they most often choose appropriate behavior. This was shown for seven of eight children who received FCT for long periods of time (several months) to request brief breaks from demands. Intermittently throughout intervention, appropriate requests were ignored for a few minutes to determine whether problem behavior would quickly reappear. During intervention for the first few weeks and even months, problem behavior almost always reappeared within 5 minutes, showing that this behavior had a lot of “strength.” However, after the problem behavior was placed on long-term extinction paired with reinforcement for appropriate behavior, the children no longer displayed problem behaviors even when their appropriate communication was not reinforced. Extinction can also assist the individual to discriminate that there is a difference between appropriate communication and problem behavior. Remember that the individual has likely been using problem behavior to obtain or maintain attention, escape, or obtain/maintain access to goods and services for a long time. In essence, the individual has learned to request reinforcement using problem behavior. Now the individual is required to learn to produce a new act that might seem similar to the individual (e.g., the difference between signing “please” and hitting one’s chest or face may not be distinct to the individual during initial training). We want the individual to quickly discriminate that appropriate communication and problem behavior are different responses that result in different outcomes. Extinction can assist us to teach this difference. We also want to avoid inadvertently teaching the individual to link or chain problem behavior with appropriate communication. For example, we do not want the individual to learn that problem behavior followed by appropriate communication is the correct “response.” Thus, if problem behavior and appropriate communication occur at almost the same time, we recommend waiting several seconds, prompting appropriate communication, and then providing reinforcement. In our previous fast-food example, we do not want to inadvertently teach the child to first engage in problem behavior, after which the parent prompts him or her to emit the appropriate communicative behavior, and then to receive reinforcement after displaying the appropriate communicative response. In this situation, we have not taught a communicative alternative but instead have taught a two-step chain of problem behavior followed by appropriate communicative behavior. Putting problem behavior on extinction reduces the probability that this two-step chain of behavior (response chain) will be learned by the child. If problem behavior and appropriate communication occur at almost the same time, the parent should wait at least several seconds before prompting

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FUNCTIONAL COMMUNICATION TRAINING FOR PROBLEM BEHAVIOR

appropriate communication. It is important to create as much “distance” as possible between displays of problem behavior and reinforcement. Teaching communicative responses that serve as alternatives to problem behavior is much easier if the individual is independent in emitting the communicative behavior. As described by Wacker et al. (1990), independent communication production provides the learner with control over the delivery of reinforcement. As learners encounter states of satiation or deprivation (i.e., motivating operations [MOs]; Michael, 1993), they can react to those states by requesting a change in the environment (e.g., a brief break from demands, access to a different toy, or access to attention). If individuals are independent in emitting appropriate communication, they can better control their environment and, thus, be better able to avoid producing problem behavior. Independent communication provides the learner with a functional alternative to problem behavior when the individual independently produces the communicative act and when the environment reinforces that act but ignores problem behavior. One might consider problem behavior and communication behavior to be in competition during FCT. If both communication and problem behavior produce the same reinforcers (i.e., are in the same response class), then the individual can choose which behavior to emit to obtain the desired reinforcer (Fisher & Mazur, 1997; Mace & Roberts, 1993). As interventionists, our task is to bias the individual’s responding such that he or she always or most often chooses appropriate communication over problem behavior. Thus, one key to success is the relation between appropriate communication and problem behavior. Extinction can influence the choice the individual makes. If the probability of obtaining reinforcement is close to 1.0 for displaying an appropriate communication response and is zero for engaging in problem behavior, then the individual will likely choose to display communicative responses over time. Unfortunately, this might take a very long time. There are situations, of course, when we are unable or unwilling to ignore problem behavior. Sometimes this is a decision we make given the severity of the behavior. In other situations, it is because we are unable to follow the intervention plan or to more closely supervise others who are working with the individual. It is particularly difficult to apply extinction when problem behavior is maintained by peer attention because it can be challenging to coach peers to ignore each other’s problem behavior. Studies (e.g., St. Peter Pipkin, Vollmer, & Sloman, 2010; Volkert et al., 2009) have shown that problem behavior can quickly reoccur (resurgence) if it receives even intermittent reinforcement or if other procedures of the treatment plan are followed with poor fidelity. In those situations in which we cannot ignore problem behavior, we need to determine how to increase the probability that the individual will display appropriate communication over problem behavior. When problem behavior cannot be ignored, it is tempting to

Introduction to FCT 7

incorporate punishment procedures to decrease the time it takes for FCT to reduce problem behavior. Several researchers (Hagopian et al., 1998; Wacker et al., 1990) have shown that including a punishment component can increase the immediate effects of FCT. Table 1.2 provides procedural descriptions for extinction procedures for problem behavior maintained by negative reinforcement in the form of escape from demands and access to positive reinforcement in the forms of tangible items and attention. As shown in Table 1.2, extinction procedures involve doing the opposite of what reinforces problem behavior. For example, if problem behavior is reinforced by escape from demands, then extinction would continue the demand, and response cost would either increase the amount of the demand or return the individual to the task if he or she is on break. We never recommend the exclusive use of reductive procedures such as extinction or punishment. Instead, we recommend using them in combination with reinforcement (e.g., differential reinforcement procedures). During FCT, this means that reinforcement is provided for appropriate communication, and that displays of problem behavior are either ignored or result in punishment. As shown in Table 1.2, each consequence component of the FCT intervention must be matched to the function of problem behavior (see Chapter 4 for a similar description of antecedent intervention components) to increase the probability of a successful intervention. If, for example, the learner’s reinforcement for problem behavior is to escape demands, then implementation of a typical time-out component would inadvertently reinforce problem behavior. Carr (1988) referred to the consistency across components as functional equivalence. If both problem behavior and communicative acts

TABLE 1.2.  Examples of Extinction by Function Maintaining consequence

Explanation

Escape from demands

Extinction would require that the learner’s escape be prohibited. Often in school settings given that restraint is a controlled procedure, it may only be possible to apply a partial extinction in which escape is made as inefficient as possible, while the more socially acceptable alternative receives dense reinforcement.

Access to attention

Extinction would require problem behavior associated with obtaining and maintaining attention is ignored.

Access to tangible

Extinction would require prohibiting access to the item or activity that is maintaining problem behavior.

Note. Consequences should not be applied in the absence of other intervention(s) that provide reinforcement for the alternatives to the problem behavior.

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FUNCTIONAL COMMUNICATION TRAINING FOR PROBLEM BEHAVIOR

produce the same reinforcement, they are said to be functionally equivalent. A similar need for functional equivalence occurs for the reinforcement and extinction/punishment components. For the FCT intervention to be maximally efficient and effective, the components of the intervention package must be internally consistent and functionally equivalent. Assumptions about the reinforcers that maintain problem behavior should be avoided, because if these assumptions are wrong, problem behavior may be inadvertently reinforced (e.g., when time out is provided for escape-­maintained problem behavior). Some years ago in an outpatient clinic at The University of Iowa that specialized in treating severe problem behavior, we discovered that over 90% of the clients referred to the clinic whose problem behavior was maintained by escape from demands were receiving interventions that included time out for problem behavior. Thus, the interventions they were receiving may have reinforced their problem behavior. One of the most common recommendations parents receive from doctors, teachers, and others is to place their child in time out contingent on problem behavior. Time out is recommended because very often it is effective in suppressing problem behavior. If a child engages in problem behavior to gain attention, such as in the previous example, then time out should be effective. However, not all children engage in problem behavior to gain attention. Some children engage in problem behavior to escape demands, nonpreferred foods, or even attention from adults. If a child is motivated to escape something and time out is the consequence provided for problem behavior, then the use of time out will reinforce problem behavior and increase the probability of its recurrence in the future. In other words, we have strengthened problem behavior, increasing its persistence (Nevin & Wacker, 2013). Knowing a problem behavior’s function, then, permits us to stop reinforcing problem behavior and to instead reinforce appropriate communication. Identifying the reinforcers via assessments of function also leads us to rely more on reinforcement during treatment and not to be overly reliant on punishment procedures (Pelios, Morren, Tesch, & Axelrod, 1999). The effective use of reinforcement requires interventionists to be proactive. They need to set up situations that guide the individual to engage in desired behavior so that they can “catch the child being good” (Barrish, Saunders, & Wolf, 1969). This can be accomplished best by knowing the reinforcers maintaining the individual’s behavior. FCT can work only if there is functional equivalence between all components of the intervention and with the reinforcers maintaining problem behavior. If there is functional equivalence, then very rapid results may occur (e.g., Wacker et al., 2011). It is for this reason, and to avoid inadvertently reinforcing problem behavior, that FCT must be preceded by a functional analysis (Durand & Carr, 1985).

Introduction to FCT 9

Functional Analysis In applied behavior analysis, function often refers to the reinforcers that contingently follow and maintain target behavior (Iwata, Dorsey, Slifer, Bauman, & Richman, 1982, 1994). Thus, behavior that is maintained by a reinforcer is said to function to produce that reinforcer. For example, if a child displays problem behavior that is maintained by attention, we would say that the behavior functions to produce attention. As shown in Figure 1.1, knowing the function of problem behavior permits us to reduce the probability of reinforcement occurring for problem behavior to 0%, or at least to a much lower percentage than prior to intervention. Conversely, we can increase the probability of reinforcement for appropriate communication to 100%, or to a much higher percentage than prior to intervention. If problem behavior and appropriate communication serve the same function (i.e., they are functionally equivalent), then the learner should choose appropriate communication much more often

100

Baseline

Intervention

85

Percentage of Intervals

70 Crying

55 40 25

Pointing to Pictures

10 –5 0

1

2

3

4

5

6 7 Sessions

8

9

10

11

12

FIGURE 1.1.  An example of what can occur when an alternative behavior is reinforced and a problem behavior is put on extinction. A 7-year-old boy with autism spectrum disorder engages in crying behavior when he wants the TV turned on. His parents begin to reinforce him with verbal praise and turning the TV on when he points to a picture of a TV instead of crying.

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FUNCTIONAL COMMUNICATION TRAINING FOR PROBLEM BEHAVIOR

than he or she chooses problem behavior, and the intervention will likely be successful. In the example discussed previously, we might teach the child to say “Help” as an alternative to producing problem behavior in the fast-food restaurant. If we provide help for appropriate requests but not for disruptive behavior, and requests and disruptive behavior are functionally equivalent, then we would expect requests to occur more often and disruptive behavior to occur less often over time. Knowing the function of problem behavior allows us to stop the reinforcement for problem behavior (e.g., mom turns or walks away) and instead to provide it for appropriate communication. When we know the function, we can increase the probability of success with FCT because we are providing the known reinforcer for manding, and problem behavior is producing either no reinforcement or much less reinforcement. Interventionists use many procedures to identify the function of problem behavior, but the “gold standard” is the functional analysis procedure developed by Iwata and colleagues (1982; Iwata, Dorsey, et al., 1994). The original procedures developed by Iwata et al. (1982, Iwata, Dorsey, et al., 1994) have remained essentially the same, with modifications developed to test different sources of reinforcement or to apply the procedures to new settings. As summarized by Hanley, Iwata, and McCord (2003), functional analyses have been studied extensively and have shown repeatedly that the results lead to effective treatments (e.g., Asmus et al., 2004; Iwata, Dorsey, et al., 1994; Kurtz et al., 2003; Wacker, Berg, Harding, et al., 1998). In home (Wacker, Berg, Harding, et al., 1998), school (Northup et al., 1994), and outpatient (Kurtz et al., 2003; Northup et al., 1991) settings, functional analyses have been conducted successfully to identify effective reinforcement-­based treatments. Relative to interventions such as FCT, most functional analyses are used to identify the positive (e.g., attention, tangible) and negative (e.g., escape from demands) social reinforcers that maintain problem behavior. An example of how a functional analysis is conducted and how an FCT intervention is matched to the results is provided in Figure 1.2. Jay was a young child with disabilities who engaged in substantial amounts of problem behaviors such as tantrums and aggression. A functional analysis was conducted by his mother at their home with parent coaching provided by an experienced applied behavior analyst. The numbers on the vertical axis are the percentage of 6-second intervals during which Jay engaged in problem behavior. The numbers on the horizontal axis represent the 5-minute sessions that were conducted during both the functional analysis (sessions 1–13) and FCT (sessions 14–33). Each session was divided into 6-second intervals and videotaped. Observers then recorded each instance of problem behavior

Introduction to FCT 11

that occurred during the intervals and summed the number of intervals containing problem behavior. The conditions conducted during the functional analysis were free play (four sessions), attention (three sessions), tangible (three sessions), and escape from demands (three sessions). As shown in Figure 1.2, problem behavior occurred almost exclusively in the escape condition, identifying negative reinforcement as the function of Jay’s problem behavior. Remember that his mother conducted every session, and thus she saw that this behavior changed with the presentation and discontinuation of demands. Many parents have told us that this really helps them to better understand why the problem behavior is occurring. Having this knowledge can give parents confidence that they will be able to teach their child a better way to request what the child wants. During FCT, which was also conducted by Jay’s mom, the same demands (picking up blocks) that occasioned problem behavior during the functional analysis were again presented, but only one block was placed on the floor for Jay to pick up. Jay’s mother first asked him and then (if necessary) guided him to pick up the block. Thus, problem behavior was placed on extinction. When Jay did pick up the block, his mother gave him very high-­quality praise and placed a microswitch in front of him with a photo on top of the switch that showed him playing. The microswitch was a large yellow button that when pressed said, “Play, please,” via his mother’s recorded voice. Thus, when Jay complied, he was praised and the switch with the photo on it was placed in front of him. When he pressed the switch, he was guided to the play area to

FIGURE 1.2. Percentage of intervals of problem behavior (destructive and disruptive) during the functional analysis and functional communication training evaluations of Jay.

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FUNCTIONAL COMMUNICATION TRAINING FOR PROBLEM BEHAVIOR

play with his mother for about 2 minutes. A timer then sounded, and he was brought back to the table to do “more work.” This work–play sequence was continued until all work was finished, and the amount of work was gradually increased across sessions. (See Harding, Wacker, Berg, Winborn-­Kemmerer, Lee, et al., 2009, for a more complete description of these procedures.) As shown in Figure 1.2, FCT initially was very successful in suppressing problem behavior. This likely occurred because these procedures were new to Jay, and his problem behavior may have decreased initially simply because of the novelty of the procedures. In addition, the demands placed on him were very small and his time in reinforcement relatively long. As the demands increased, so did his problem behavior, but each time only briefly. By the final sessions, Jay was doing much more work, and his problem behavior, although still occasionally occurring, was mild and of short duration. The FCT intervention then replaced problem behavior with task completion and appropriate communication. These results are representative of the typical results we obtain. FCT often has very good initial effects, but longer-­term treatment is often needed for maintenance (Wacker et al., 2011).

As discussed by Tiger et al. (2008), a substantial number of studies such as the one shown in Figure 1.2 have now been published. Most of these studies were conducted to provide examples of successful FCT (e.g., across settings, subgroups, or behaviors), to test the effects of FCT in novel situations (e.g., long-term maintenance), or to compare FCT with other treatments or when combined with other treatments. The results of these studies have provided a wealth of information about FCT and especially about the role of reinforcement in treatment programs. Most of this information was a direct result of the inclusion of functional analyses conducted prior to treatment to identify the reinforcers maintaining problem behavior. As first discussed by Durand and Carr (1985), functional analyses are a critical first step in conducting effective interventions with FCT. For the remainder of this book, we assume that a functional analysis has been conducted and has identified a social reinforcer for problem behavior. By social, we are referring to behavior maintained by attention, tangibles/activities, or escape from demands rather than behavior that produces its own reinforcement (e.g., automatic reinforcement). Our focus is on the remaining two components of FCT: identifying the specific communicative responses to be trained and, especially, identifying the specific training procedures to be used during FCT.

Chapter 2

The Selection of Communicative Function(s) to Teach and How They Are Expressed

Establishing

a communicative alternative to problem behavior will be effective only if the learner finds it to be a more effective or efficient alternative than the current communicative strategies (which include problem behavior) he or she uses (Horner & Day, 1991). In this chapter, we describe methodologies used in the early work addressing the selection of communicative intents (reasons for producing a communicative act) as well as communicative means (form of communication used; spoken [and/or] gestural [and/or] graphic). The basis for making this decision is the matching law (Herrnstein, 1961)—which suggests that an individual’s response rate will be proportionate to the immediacy, amount/duration of positive reinforcement, and the response effort to gain reinforcement—­and the practical operationalized parameters of “response efficiency.” Our discussion begins with the reasons why the learner is engaging in problem behavior. Those reasons can be a motivation to influence the actions of others in the environment. When this occurs, we say that problem behavior serves a social function (purpose). Alternatively, problem behavior may occur as a reaction to a biological condition (e.g., an earache) that is not specifically intended for a listener’s benefit. As mentioned in Chapter 1, we deal primarily with social functions associated with problem behavior; selecting a communicative alternative for an existing problem behavior requires the best possible match between the reason for the problem behavior and the communicative act chosen to replace it. In teaching that act, it is important

13

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FUNCTIONAL COMMUNICATION TRAINING FOR PROBLEM BEHAVIOR

that the learner either already attempts to influence the actions of others or can be taught to do so. Thus, the first section of this chapter addresses the emergence of a learner’s attempts to influence others and the range of communicative acts that can be acquired. Regardless of the type of communicative act chosen for intervention, an important consideration is the representational specificity of the actual symbol chosen for implementation. Representational specificity refers to the range of objects and actions to which the communicative act chosen can apply. For example, a request for an object (regardless of communicative means) could be communicated using “Pepsi,” “drink,” or “want,” depending on the vocabulary of the learner and the specificity desired by others in the environment (see Reichle, York, & Sigafoos, 1991; Reichle & Brady, 2012). Considerations for making that choice are discussed in the middle section of this chapter. The latter portion of the chapter addresses how to best select the communicative means that will be most efficient.

What Events Lead to the Learner’s Overt Attempts to Socially Influence Others? The term communicative function is often used in discussing an individual’s initial communicative repertoire (Carr & Durand, 1985; Wetherby, Reichle, & Pierce, 1998). Communicative function describes the outcome of behavior produced that actually influences the actions of others. If a learner repeatedly produces a particular behavior that in turn leads to specific outcomes (e.g., to gain attention or escape demands), it becomes increasingly clear that he or she is interested in the predictable effect that follows. However, it does not follow that all communicative functions are communicative intentions. The two terms refer to somewhat different phenomena. Wetherby and Prizant (1989) defined communicative intentionality as the deliberate pursuit of a goal that is produced for the benefit of a listener. Bates, Benigni, Bretherton, Camaioni, and Volterra (1979) described it as “signaling behavior in which the sender is aware apriori of the effect that a signal will have on his listener” (p. 36). Although seemingly straightforward, it is fairly difficult to directly measure communicative intentionality. Instead, intentionality must be inferred from the learner’s behavior and his or her social partner’s reactions. Some may confuse intentional behavior with engaging in intentional communicative behavior. In terms of typically developing learners, it is not unusual to see a 7-month-old attempt to open a container intentionally. However, after struggling to solve the problem, he or she may not realize that an adult

The Selection of Communicative Functions 15

can be used as an agent to gain access. In the preceding example, the child engaged in intentional behavior but not intentional communicative behavior that was intended for the benefit of others. Function describes the outcome resulting from a learner’s behavior. For example, in response to crying, a parent may provide a bottle of milk to an infant. If hunger precipitated the cry and if the sequence described occurs repeatedly, the probability of crying would increase around mealtime. The layperson would conclude that the function of the learner’s behavior is to obtain a desired object/event (e.g., a bottle), and a behavior analyst would agree if an experimental analysis verified that acquiring an object was the function of the learner’s behavior. However, the learner’s behavior may not be produced for the benefit of a listener. Wetherby and Prizant (1989) suggested criteria that could be used to assist in determining whether a learner’s communicative behavior is intentional. Rather than relying on any single criterion, most researchers in the speech, language, and hearing sciences use a collective set of criteria in making this determination. The greater the number of these criteria that can be observed in an interpersonal exchange, the stronger the case for an intentional act. Although specific criteria employed have differed (cf. Harding & Golinkoff, 1979; Mclean, McLean, Brady, & Etter, 1991; Wetherby & Prizant, 1989), there appears to be agreement on several, including (1) alternating eye gaze between object/event of interest and one’s communicative partner, (2) persistent signaling until a goal is accomplished or failure indicated, (3) waiting for a response from a listener after an initial communicative act has been produced, (4) changing the signal quality until the goal has been met (e.g., speaking louder), and (5) ritualizing or conventionalizing communicative forms (e.g., doing what one’s older brother does to obtain a desired item). Being intentional but not communicatively intentional may make it more challenging to acquire functional communicative behavior. However, there are reports of learners who, initially, only engaged in intentional behavior being taught to engage in intentional communicative behavior. In this book we use the term function, even though for the most part we are also referring to procedures to teach learners communicative behavior that they will produce an overt attempt (intent) to influence social partners. The reason for this is that even though the distinction between function and intent is correct, convention tends to use function to refer to both and function can be directly observed and analyzed. Applied behavior analysts define these communicative acts as mands. Skinner (1957) defined a mand as “a verbal operant in which the response is reinforced by a characteristic consequence and is therefore under the functional control of relevant conditions of deprivation or aversive stimulation” (pp. 35–36). The consequence is the word specified in the mand.

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FUNCTIONAL COMMUNICATION TRAINING FOR PROBLEM BEHAVIOR

Identifying Specific Types of Functional Communicative Acts That Can Be Produced by Individuals Who Engage in Problem Behavior As mentioned in preceding paragraphs, Wetherby and Prizant (1993a) described categories of communicative intents that were largely based on those that had been described previously by other language researchers (e.g., Bruner, 1975, 1977). In the area of language intervention, these categories have been widely accepted by speech and language pathologists and educators in describing typical, delayed, and atypical communicative production. Three basic communicative functions (intents) include behavior regulation, joint attention, and social interaction (see Table 2.1).

TABLE 2.1.  Definitions and Examples of Three Classes of Communicative Functions Communicative function

Definition

Examples

Behavior regulation

Communicative acts used to regulate the behavior of another person to obtain a specific result (Wetherby & Prizant, 1993a)

•• Request for specific object or action •• Rejection of an object, action, activity, or attention

Joint attention

Communicative acts used to direct another’s attention to an object, event, or topic of a communicative act (Wetherby & Prizant, 1993a)

•• Comment on an object or action •• Clarification—utterances used to repair previous utterances

Social interaction

Communicative acts used to attract or maintain another’s attention to oneself (Wetherby & Prizant, 1993a)

•• Greeting—gaining or terminating the attention of another individual •• Request for social routines— initiates routines such as peeka-boo or pat-a-cake •• Showing off—attracts another individual’s attention •• Requests permission—seeks approval to carry out an activity •• Personal—expresses one’s moods or feelings

Note. Adapted from Wetherby and Prizant (1993a) with permission from Paul H. Brookes Publishing Co., Inc.

The Selection of Communicative Functions 17

Behavior Regulation Producing a behavior regulation act involves influencing the actions of others so that the learner can obtain or maintain contact with desired objects/ people/activities or alternatively to escape or avoid these same things. Examples of behavior regulation communicative acts include requesting objects, requesting actions, and protesting. Among learners who are not yet producing spoken words (prelinguistic), behavior regulation communicative acts account for approximately 36% of their total communicative acts produced (Wetherby & Prizant, 1993a). Behavior regulation is a class of communicative functions that are equivalent to mands. Taken collectively, requesting objects and actions, as well as protests, serve the same function as mands and among speech and language pathologists, they are described as examples of behavior regulation.

Joint Attention During joint attention communicative acts, the individual is interested in directing a communicative partner’s attention to an object or event in order to show it to his or her partner. Interventionists often describe instructional objectives that are designed to teach learners to comment on objects or actions, request information, or provide clarification. Among typically developing beginning communicators, joint attention acts account for just under 50% of total communicative acts produced (Wetherby & Prizant, 1993a).

Social Interaction During a social interaction communicative act, an individual directs the attention of others to him- or herself. Examples include greetings, requesting a social routine (such as requesting peek-a-boo), calling, and acknowledging comments produced by social partners. Among beginning communicators, these communicative acts account for a relatively small proportion of total communicative acts produced.

Considering the Relationship between Social Functions of Problem Behavior and Communicative Intents Discussed by Speech and Language Pathologists Problems in terminology can create communicative challenges across disciplines. For example, speech and language pathologists often have a more developmental or social pragmatic orientation, while applied behavior

18

FUNCTIONAL COMMUNICATION TRAINING FOR PROBLEM BEHAVIOR

analysts have a more operant or functional approach to intervention. The two disciplines may often use the same terminology to mean somewhat different phenomena. In an attempt to get these disciplines on the same page, we briefly discuss this terminology issue with respect to FCT. Descriptions of intentional social/communicative functions described in the positive behavior support and applied behavior analysis literature typically involve three social functions that include obtain/maintain attention, obtain/maintain goods and services, and escape/avoid. Of course, many individuals engage in more than a single social function that is associated with problem behavior. Unfortunately, there may not be a one-to-one correspondence between social functions and communicative functions. For example, requests for assistance can be produced with a social intent of “obtain desired objects,” as when a learner has difficulty opening a toy in a cellophane wrapper. Alternatively, the same learner could use an assistance request to more quickly finish an undesired task, as when a young learner asks for help picking up toys in order to quicken the task. Correspondingly, an individual may engage in problem behavior that is associated with escape. In one situation, the learner may escape the work because it is not preferred. In other situations, the learner may attempt to escape because the work is very difficult. Of course, the most efficient communicative act to use with activities that go on too long is to request a break. With difficult activities, however, it makes more sense to request assistance than to request a break since a break will not really provide the needed tutoring. This latter instance may explain why during some difficult tasks we have problems with working consistently in a room where there is a TV. We may take frequent breaks to watch TV, which is reinforced by avoiding the task. Thus, we continually postpone engagement and never complete the task. Reichle, Drager, and Davis (2002) suggested that learners may have generalization boundaries that make it difficult for them to generalize a single communicative intent that may be useful for each of two very different social functions associated with problem behavior. They worked with a learner who had significant developmental disabilities. They taught the learner to use requests for assistance when presented with a task that was aversive (probably because of its difficulty). At the outset of the investigation, they also identified a group of activities that were highly preferred but could not be independently accessed by the learner (e.g., unwrapping candy that was difficult to unwrap). Initially, the learner was taught to request assistance with difficult tasks that he attempted to escape. They observed that he began to generalize from examples involving nonpreferred materials to other nonpreferred activities that had not been associated with the intervention procedure. However, they also observed that no generalization occurred with activities that involved an inability to obtain difficult-­ to-­access objects. One interpretation of the results is that some persons

The Selection of Communicative Functions 19

who engage in problem behavior may struggle with generalizing at least some communicative functions (intents) across social function boundaries. In applied behavior analysis, we would describe this in terms of response classes. Teaching communication acts that appropriately generalize across response classes may be quite difficult and may not usually occur without specific intervention (Falcomata, Wacker, Ringdahl, Vinquist, & Dutt, 2013). Consequently, it may not be sufficient to think of generalization only across perceptual boundaries, like color, shape, and the size of referents. Our purpose here is to demonstrate that a single communicative function can be utilized across several different social functions associated with problem behavior. Further, one cannot assume that will happen without carefully implemented intervention.

Why Is It Important to Exactly Match Communicative Intents to Be Taught with Social Functions Derived from a Functional Assessment? Carr and Durand (1985) demonstrated that unless the communicative alternative that is chosen is an exact match to the communicative intent associated with the problem behavior, the interventionist will not get a deceleration of the problem behavior. To take this notion a bit further, consider that a mand can encompass communicative functions that include but are not limited to requesting (“I want that”), protesting (“No”), requesting assistance (“Help me”), or requesting a break (“I’d like to take a break”). Each, in turn, could be a differentially effective communicative alternative depending on the function of the problem behavior. For example, requesting a break is apt to be more reinforcing than requesting assistance during a task in which the learner is competent but simply goes on longer than the learner anticipated. In this case, the MOs for negative reinforcement increase the value of escaping the task. Correspondingly, requesting assistance may be viewed as being more efficient during a task that the learner has not yet mastered. Taken together, this suggests that it is important for the function of the behavior to be precisely identified as a result of the functional assessment process. Consider the following examples that address the specific match between the response to be taught (new communicative alternative) and the reinforcement that the learner is attempting to obtain. A functional analysis revealed that Pete’s tantrums were maintained by escape. However, after a follow-­up functional analysis of all difficult problems, it became clear that Pete tantrumed only when receiving “difficult” problems for which he was successful during fewer than 50% of the opportunities

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FUNCTIONAL COMMUNICATION TRAINING FOR PROBLEM BEHAVIOR

that were provided. Problems that Pete successfully completed during 75% or more of the opportunities that they were provided rarely resulted in problem behavior. A functional analysis also demonstrated that Sallie’s aggression was maintained by escape. However, with Sallie, the MO for aggression involved the duration of a task. When a task lasted longer than 10 minutes there was a high rate of aggression, regardless of the difficulty of the task. However, with tasks that were 7 minutes or less, there was an extremely low rate of aggression. Although both of these learners’ original functional analyses yielded results consistent with negative reinforcement (escape), Pete would best be served with an intervention designed to teach him to request assistance. Sallie, on the other hand, would best be served by an intervention designed to teach her to request a break.

One must also consider tacts (even though the bulk of the FCT literature discusses using mands as an alternative to problem behavior). Skinner (1957) defined tacts as those communicative acts that could be reinforced with a generalized set of reinforcers. For example, one may say, “Look at that dog” to engage someone in the conversation and to which the person could say a number of things that would be responsive. Tacts may include a relatively large class of communicative intents that could include but not be limited to labels, comments, greetings, and jokes. Thus, a number of communicative functions may prove to be functional alternatives for challenging behavior (in this case, requesting attention). From the standpoint of the speech and language pathologist, tacts can potentially represent a mix of joint attention and social interaction communicative functions. Once the interventionist has addressed the communicative function (intent) that best addresses the functional reason associated with the challenging behavior, the interventionist can consider the meaning of the symbol to “map” on to the communicative intent. If a learner is engaging in a tantrum to obtain snacks at a time and place where it is appropriate to obtain them, the communicative function is to obtain access to preferred items. Having made that determination, the interventionist could further determine that it is beverages that the learner virtually always attempts to procure. In selecting a specific symbol (graphic, gestural, or spoken), the interventionist could choose “drink,” since the interventionist almost always has only one beverage available during snack time. Additionally, “drink” will generate a greater number of opportunities for practice throughout the day. On the other hand, if the learner is an adult being taught to order beverages at fast-food locations, “drink” will not be a very efficient symbol compared with teaching more specific symbols.

The Selection of Communicative Functions 21

Selecting the Most Efficient Representation for a Particular Communicative Act When the interventionist selects the actual symbol to teach a learner, it could be either very explicit or very general. In the earlier example, “Pepsi,” “drink,” or “want” could be used to make a request. Eventually, one would plan to teach general and explicit vocabulary items that could be used with the same referent (e.g., “Want Pepsi”). However, in establishing an initial communicative repertoire, the interventionist may not have this luxury. Consider, for example, a learner who is ordering food at a McDonald’s fast-food restaurant. In this context, fairly explicit vocabulary items are required in order for the learner to participate independently (keeping in mind that in this context the objective is to place an explicit order as quickly as possible). Consequently, if a learner usually ordered milk, the most plausible vocabulary item would be a symbol representing “milk” rather than a more general symbol representing “drink.” Consider a second example of a somewhat more sophisticated graphic mode communication application for a learner who uses a small communicative notebook (or a speech-­generating device that permits one symbol selection linking to another page of symbols). As his or her repertoire of symbols and corresponding messages continues to grow, organizing the symbols becomes important. For example, consider a learner who has no more than six symbols displayed on a single page of his or her multipage communication device. For this learner, it is likely that the first page of his or her device will function as an index. If so, it is possible that “places where I like to eat” will be one symbol on the main page. If this symbol is selected, it might link to each of eight fast-food restaurant logos. Consequently, if a learner wanted to go to McDonalds for a Big Mac, he or she would have to first select “eating places” followed by a “golden arches” symbol selected from the linked symbol page. This, in turn, would result in a pop-up with all of the items that the learner has a history of ordering. Being able to engage in this chain of responses requires that the learner be able to engage in hierarchical matching. The learner must be able to match a superordinate symbol (“places where I like to eat”) to the sample (french fries—what he or she is after) in order to begin the chain of events that communicates his or her message. In this section of the chapter, we consider decisions that the interventionist must make about the specificity of symbols that can be used by the interventionist in establishing a beginning communicative repertoire. Further, it is predicated on learning a range of symbol specificity. With other learners, the task is just to begin a symbol repertoire. For these individuals, symbol specificity also has an important role, as was the

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case in our example of the learner who wished to order the Big Mac from a single page of menu choices that was available once he or she arrived at McDonald’s. Regardless of the sophistication of the symbol system being considered, we address considerations in choosing symbol specificity.

Identifying a Continuum of Symbol Specificity Symbol specificity determines how much context and/or listener inference is required to understand a learner’s message. For example, at the most general level is the symbol “want.” At the most explicit level is the symbol “Oreo.” At an intermediate level of specificity, we have chosen “cookie.” Assuming that one is attempting to request an Oreo cookie, an interventionist could have chosen a symbol from a variety of levels of specificity as an initial symbol choice. We know that, initially, typically developing learners tend to master symbols at an intermediate level of specificity (i.e., “dog” rather than “animal” or “collie”; Reichle et al., 1991). At slightly later points in development, they tend to acquire more “superordinate” (animal), as well as “subordinate” (collie), levels of symbols. Of course there are exceptions to this tendency, and as we know, what occurs in normal development can be helpful to the interventionist but does not necessarily preclude considering other options.

Considering Possible Variables That Influence Choices Regarding Symbol Specificity In discussing symbol specificity, we use the communicative intent of requesting objects. One of the most general symbols that could be selected to communicate that there is something that the learner wants would be a symbol signifying “want.” This general symbol offers several advantages for both learner and interventionist. First, a more general symbol such as “want” allows the interventionist to create learning opportunities across a wide range of objects and activities that occur throughout the day. Second, there is an increase in the likelihood that the interventionist can implement teaching opportunities with highly preferred items/activities at any given point in time. Taking advantage of the learner’s motivation may increase the number of teaching opportunities that are available. Finally, given that teaching initial symbol discriminations can require many teaching opportunities, a learner could become satiated on items or events that at the outset of intervention appeared to be highly preferred. A more general symbol allows the interventionist flexibility in addressing learner preference shifts. Thus far, it seems as though general symbols might be more advantageous as an initial intervention target than more explicit symbols. Unfortunately, there are some disadvantages associated with general symbols.

The Selection of Communicative Functions 23

General symbols tend to require a greater level of inference by social partners. For example, if one travels to McDonalds, approaches a clerk and touches a symbol “want,” the clerk will not know enough about the learner’s preferences to make a correct inference about the item being ordered. Therefore, general symbols make the learner far less independent in community environments than explicit symbols. The advantages and disadvantages for explicit symbols are more or less the reciprocal of those described for general symbols. In addition to considering communicative intents and symbol specificity to use in teaching an initial socially acceptable communicative repertoire, one must also consider the communicative means that will be used by the learner as the mechanism that conveys communicative functions and meanings. In the next section of this chapter, we address the alternatives that are available to an interventionist.

Identifying the Specific Communicative Means to Be Taught For some individuals, the selection of alternative communicative behaviors is not difficult because the individual has mastered all of the responses that are needed. In this instance, the interventionist’s task is “simply” to arrange the consequences so that the individual is more likely to communicate appropriately than to engage in problem behavior. We say “simply” in quotes because this is often quite challenging for the parent and/or educators. For other individuals, first we have to determine what communicative means (mode) to teach. For example, some individuals with severe intellectual disabilities receive instruction to communicate using a variety of communication modes, including graphic symbols (e.g., printed words; pictures; line-drawn symbols that may or may not be associated with synthesized speech, signs, or gestures; and vocalizations or intelligible spoken words). One reason for considering multiple modes of communication is that we are not sure which will be most effective for the individual (or which will be most efficient in a given situation). Several investigations have compared communicative mode preference and efficiency for learners with autism spectrum disorder and individuals with significant levels of intellectual disabilities. Universally, there is no single mode that is the most efficient or easiest to learn (see Adkins & Axelrod, 2001; Anderson, 2002; Chambers & Rehfeldt, 2003; Charlop-­Christy, Carpenter, Le, LeBlanc, & Kellet, 2002; Ganz & Simpson, 2004; Tincani, 2004). However, it is quite likely that different communicative means (i.e., forms, topographies) are apt to be universally more effective for any given learner. For example, a learner with significant upper extremity and speech motor involvement may find graphic symbols universally more efficient than gestures or speech.

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Alternatively, for other individuals, the efficiency of a particular communicative means may be context specific. For example, gesturing in a noisy environment may be more effective than speaking. However, care must be taken to ensure that introducing several different communication modes will not create confusion for either the learner or the interventionist. There is no single procedure for identifying which communicative response would be best to introduce first, but the communicative means that is taught may impact the success of the intervention. Some of the variables to consider when selecting the specific communicative response are provided in Table 2.2. Horner and Day (1991) showed that a communicative act must be at least as efficient as problem behavior for obtaining reinforcement, or the individual might choose to continue to engage in problem behavior. If both the socially acceptable communication act and the problem behavior produce reinforcement, then the individual will likely choose the option that is more efficient or effective. Horner and Day (1991) evaluated three dimensions of efficiency: (1) physical effort, (2) delay between response and reinforcement, and (3) schedule or amount of reinforcement. In their study, there was a much higher probability of the display of appropriate communicative responses than of problem behavior if the communicative responses were more efficient on one or more of these dimensions. Other researchers (Harding, Wacker, Berg, Winborn-­Kemmerer, Lee, et al., 2009; Hanley, Iwata, & Thompson, 2001; Richman, Wacker, & Winborn, 2001) have shown similar results. For example, Richman et al. (2001) showed that the response effort related to manding and problem behavior impacted the success of FCT. Specifically, these authors evaluated the effects of two appropriate communicative means produced by a learner (handing a communication card to his mother and signing “Please”) and the learner’s aggression on obtaining preferred toys. When toys were available for signing (the least effortful response), handing the card to his mother (the next effortful response), and aggression (most effortful), the learner always signed. When signing did not produce reinforcement, he used the word card. He used aggression only when neither of his appropriate mands resulted in the desired reinforcer, toys. Thus, in selecting communicative means, we must consider how the means “compete” with problem behaviors in terms of their effectiveness in producing reinforcement, the physical effort needed to produce reinforcement, the delays to reinforcement, and the amount of reinforcement. The second variable listed in Table 2.2 is the history of reinforcement that has followed specific communication responses. Nevin and Wacker (2013) described how the persistence of responding during long-term intervention is often a function of its history of reinforcement. Responses with more substantial histories of reinforcement will persist longer when

The Selection of Communicative Functions 25 TABLE 2.2.  Variables to Consider in Choosing the Specific Communicative Response during FCT Variable

Reason

Efficiency

If the communicative response is more efficient (results in more immediate higher quality reinforcement or requires less response effort) than problem behavior, it will likely be emitted before problem behavior.

History of reinforcement

Communication responses that have been reinforced at a high rate will have greater response strength than those that are novel.

Relation to problem behavior

If the communication response is closely correlated with problem behavior, problem behavior may show greater resurgence.

Preference

If the learner prefers one response over another, this may increase the long-term use of the response.

Signaled

If the appropriate communication response is signaled that will increase the probability that it will occur. This is one reason we often use word cards or microswitches; they signal when reinforcement will occur.

not reinforced than will responses with less substantial histories of reinforcement. This view of behavioral persistence is based on the theory of behavioral momentum (Nevin & Grace, 2000a) and provides a theoretical account of why some responses persist, others quickly fade, and still others show resurgence (Lattal & St. Peter Pipkin, 2009) after periods of nonoccurrence. The long-term goal for FCT is to train appropriate communication behaviors in such a way that they persist (i.e., are maintained), even when they encounter brief periods of extinction or other challenges to treatment. Thus, during the initial FCT intervention, the goal is for the appropriate communicative act to replace problem behavior—­that is, if the learner maintains a propensity to revert to problem behavior as part of a response class, at least the desired behavior will be produced first (Lieving & Lattal, 2003; Richman et al., 2001). However, it is also important that the appropriate communication responses persist even when they are ignored so that the learner does not revert to problem behavior very quickly. In all reinforcement-­based intervention programs, including FCT, one challenge with the intervention is that problem behavior often quickly reoccurs even if it has not occurred for relatively long periods of time. This recurrence is referred to as resurgence (Lieving & Lattal, 2003; Volkert et al., 2009) and probably occurs because the problem behavior historically has been reinforced at a high rate. Although we often consider a response

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as “gone” or “eliminated,” in fact, it is most likely only suppressed and can quickly reoccur when changes in intervention (e.g., fading of reinforcement) occur, either intentionally (e.g., fading of reinforcement; Wacker et al., 2011) or unintentionally (e.g., problems with treatment fidelity; Lattal & St. Peter Pipkin, 2009). As FCT is conducted for longer periods of time, the strength of appropriate communication and other prosocial behaviors increase relative to problem behavior, which is weakened due to extinction. By strengthened, we mean that the response has a higher probability of being emitted in the future than does a relatively weaker response (Nevin & Wacker, 2013). For example, Wacker et al. (2011) showed that FCT strengthened task completion as well as communication for young learners whose problem behavior was maintained by negative reinforcement. When requests for breaks were not immediately reinforced, learners continued to comply, especially later after months of intervention. During the initial periods of intervention, problem behavior showed resurgence within 5 minutes when manding for a break was not immediately reinforced. The good news is that problem behavior eventually failed to resurge, but this failure took months of intervention. The third variable listed in Table 2.2 is the relation of appropriate communicative behavior to problem behavior. Winborn, Wacker, Richman, Asmus, and Geier (2002) evaluated two communicative acts during FCT: (1) an “existing” act that had a history of being associated with problem behavior, and (2) a novel act that had no history of being related to problem behavior. Both were effective in reducing problem behavior during FCT, but higher levels of problem behavior occurred with the existing acts. Unfortunately, when the learner was given a choice of which to produce, he chose the existing act. The continued use of the existing act would likely require a longer period of intervention before resurgence of problem behavior was no longer an issue. In the Winborn et al. (2002) study, preference was shown to be a function of the familiarity of the communicative act—that is, less familiar acts were preferred. Winborn-­Kemmerer, Ringdahl, Wacker, and Kitsukawa (2009) conducted a follow-­up study that specifically evaluated preference, the fourth variable listed in Table 2.2. Winborn-­Kemmerer et al. (2009) evaluated whether participants would show a preference between two novel communicative acts. They taught two participants to emit two novel communicative acts during FCT. Both acts were effective in reducing problem behavior. Following intervention, each participant showed a preference for one act over the other. Preference for specific communicative acts may be an important variable for long-term treatment with FCT. The results of Wacker et al. (2011) showed that for negative reinforcement effects to persist for even brief periods of extinction, very long-term intervention was needed. Similarly, Berg

The Selection of Communicative Functions 27

et al. (2007) showed that relatively long-term FCT intervention was needed for generalization to occur across novel people, settings, and tasks. Given that successful intervention requires both persistence and generalization, we should expect it to continue for a long period of time. Selecting communicative responses that are preferred by the learner may assist us in prioritzing long-term selection of a response. As shown in Wacker et al. (2011), we need to be prepared to continue FCT even after problem behavior has failed to occur for a long period of time. If we attempt to stop FCT too quickly, or even to fade the level of intensity of treatment, problem behavior may show substantial resurgence, and socially acceptable communicative alternatives and other appropriate behaviors may fail to persist or to generalize. One variable that may be important for long-term FCT is the learner’s preference for a specific communicative means. If, for example, the learner prefers to sign rather than to hand over a picture, he or she might persist longer with signing than with picture exchanges. Just as we conduct preference assessments for leisure items, we may also want to conduct preference assessments of communicative means (even though they may be context specific), as described by Winborn-­Kemmerer et al. (2009).

Chapter 3

An Integrative Model to Establish Communicative Alternatives and Enhance Self‑Regulatory Skills

Teaching

an alternative communicative response to replace a problem behavior that has a long history of being reinforced involves a multicomponent behavior support plan that comprises many interrelated parts. Once the function of the problem behavior has been identified and is ready to be replaced with an appropriate alternative behavior, it is important to consider the intervention components. In the case of teaching a communicative alternative (which is the primary focus of this book), rarely will it be sufficient for the learner to simply make a request whenever someone else is present. The communicative alternative being taught must be under good stimulus control (e.g., the learner discriminates when and when not to emit the communicative response); it has to occur in the right settings, during the right activities, with the right people, and at the right times. Additionally, it is very important that the learner not use his or her new communication skill during activities and with people or at times when it would not be socially acceptable. The learner must identify stimuli—­such as the setting, person, activity, or time—and knows when producing the communicative response will and will not be reinforced. When the learner is able to discriminate that displaying the communicative response will likely be reinforced in some novel contexts, but not others, then we say that stimulus generalization has occurred. In most cases, before we can state that FCT has been successful, we need to show that stimulus generalization has occurred. Similarly, we need to show that maintenance has occurred. Once the learner is displaying appropriate communication rather than problem

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An Integrative Model 29

behavior under the right stimulus conditions, he or she should continue to do so in the future. Intervention should help weaken the problem behavior while strengthening the alternative communicative behavior over time. However, in activities where the new communicative alternative cannot be reinforced, some other alternative support or intervention strategy is needed. This means that the context in which intervention occurs should be carefully considered, as should the events leading up to the alternative communicative behavior. This chapter offers a model that is a balance between teaching learners to advocate for themselves by controlling the delivery of consequences using socially acceptable communicative behavior, while learning to regulate their behavior in the context of the environments in which they must operate (conditional use of communicative alternatives). An example of conditional use of a communicative alternative to problem behavior can be illustrated around requesting cookies. In many households, it is acceptable to request a cookie after a meal. On the other hand, repeating five successive requests for cookies within a short span of time would be considered unacceptable. Thus, intervention to teach a new communicative alternative to problem behavior must carefully address teaching the learner how to moderate his or her newly acquired requests in addition to teaching the contexts in which a request will and will not (or is less likely to) be reinforced (Fisher & Mazur, 1997). Typically, we think of the generalized use of newly acquired communicative behavior as desirable. However, conditions arise that make it necessary for the learner to make good decisions about when to use and when not to use a particular communicative behavior. Some of the discriminations required to make these decisions can be quite subtle. For example, assume that one wants ketchup while eating a burger and fries. If the ketchup bottle is nearby, the learner should independently pick it up and use it when desired. On the other hand, if the ketchup bottle is on the other side of the table directly next to someone else, a better choice might be to request it. Similarly, if one has requested and been given a break, it would be inappropriate to request an additional break upon returning to work. The preceding examples demonstrate contexts where it is and is not acceptable to use a communicative alternative to problem behavior. In some of these situations, it will always be inappropriate to generalize the use of a newly taught socially acceptable communicative act. For example, in the case of rejecting the offer of seizure control medication, the interventionist will need intervention strategies that will “cushion” the aversive taste of the medication but will not allow escape. Other situations are much more contextually bound, as in our example of how many cookies can be requested, or when it might be appropriate to request the next break. Specific interventions to address the situations just described are provided in Chapter 4.

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In this chapter, we address an instructional framework that is designed to help interventionists consider the “desirable spread” of generalization that they hope to achieve while minimizing undesired generalization. We refer to this instructional framework as general case instruction (see Horner, McDonnell, & Bellamy, 1986; DePaepe, Reichle, & O’Neill, 1993, for a detailed tutorial). Fisher, Kuhn, and Thompson (1998) also discussed the importance of requiring the interventionist to consider situations where the use of a newly established behavior should not occur. The goal of this framework is to establish the conditional use of newly established communicative alternatives that result in better self-­regulated behavior. It is important to consider the challenges that confront learners who engage in problem behavior that is maintained by the actions of other social partners. We suspect that many learners find themselves being tugged between a desire to empower (obtain reinforcement now) and self-­regulate (appropriately control) their actions. For many learners, empowerment wins. This, in turn, can lead to increased problem behavior, which is maintained because others reinforce it in the learner’s environment in an effort to get the problem behavior to stop. For example, consider a child who is screaming to gain access to a toy. Giving him or her the toy increases the likelihood that screaming will decrease in the short run, but increases the probability of screaming occurring again should the same situation arise in the future. In this example, screaming is negatively reinforcing to the child’s parents because an aversive stimulus (a crying child) stopped. Given this relationship, it is important to implement support not only to teach socially acceptable communication (to empower the learner), it is also important to implement strategies that increase the likelihood that the learner will better self-­regulate his or her behavior over time so that when parents really cannot provide a toy, the example just described will not repeat itself. Given the importance of the concurrently supporting strategies of self-­regulation and empowerment, we briefly provide an overview of both.

Self‑Regulation Baumeister, Vohs, and Tice (2007) characterized self-­regulation as one’s capacity to alter behaviors to address standards, ideals, or goals based on the expectations of the social community in which one operates. They suggested that being flexible in adapting to unanticipated features of the environment is critical in becoming socially competent. Among persons with significant neurodevelopmental disabilities, self-­regulatory competence can be challenging. Baumeister et al. concluded that those who have acquired more sophisticated self-­regulatory skills had greater success in school, work,

An Integrative Model 31

and social relationships. Thus, enhancing self-­regulatory skills among individuals with limitations in this area is well worth the effort. Many individuals with whom we work are impulsive and often have difficulty delaying reinforcement; delays to reinforcement can serve as an establishing operation for problem behavior (Vollmer, Borrero, Lalli, & Daniel, 1999). For these persons, there are strategies that can enhance their self-­ regulatory skills. For example, Falcomata, Cooper-­ Brown, Wacker, Gardner, and Boelter (2010) implemented an assessment of self-­ control with nine children seen in an outpatient clinic serving children who engaged in impulsive, hyperactive, and inattentive behaviors. Assessments were implemented involving a choice between two concurrently presented math or writing tasks, with one alternative reflecting impulsive responding and the other alternative reflecting self-­control. For the participants who demonstrated impulsive responding during baseline, researchers systematically varied reinforcer quality, delay to reinforcement, and response effort to evaluate the effects of these dimensions on the choices made by the learners. Three participants displayed self-­control responding, and six participants displayed impulsive responding during baseline conditions. Of the participants who displayed initial impulsivity, all showed self-­control when one or more response or reinforcement dimension was altered to bias responding within a brief multielement design. Results demonstrated a potentially useful application of how manipulating concurrent schedules can be used to evaluate potentially successful strategies to modify the likelihood of impulsive behavior. Chapter 4 provides detailed information on strategies that can enhance and support improved self-­regulatory skills.

Empowerment and Self‑Efficacy Empowerment and self-­efficacy represent important components of a well-­ regulated behavioral repertoire (Ozer & Bandura, 1990). Critical to the notion of empowerment is self-­ efficacy, perceived competence, and the motivation to be less dependent on other individuals. Communicative alternatives to problem behavior represent a way for individuals to advocate for themselves and be less dependent on others in their environment. In this sense, establishing a conventional communicative repertoire can empower a learner. On the other hand, the empowering tool of independent communication can have just the opposite effect when it is overused. Learners who are capable of independent engagement but instead overuse skills such as “requesting help” can become overly dependent on others, which can decrease independence (Hanley et al., 2001). Being able to make good judgments about when to independently engage in activities and when to

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use communication as a mediating tool for assistance represents an important skill that we believe receives limited attention from interventionists. As mentioned by Wacker et al. (1990), independent communication permits the individual to react to changing states of deprivation and satiation by manding for more or less of a given stimulus. In this way, the individual can regulate the impact of the social environment. In this chapter, we describe a framework that we believe can assist learners in maintaining a balance between well self-­regulated behavior that allows them to engage in some activities that (1) remain aversive but must involve their participation or (2) require their patience prior to obtaining the item, activity, or attention desired. Increasing their persistence while engaging in nonpreferred tasks is as important as providing a socially acceptable alternative to problem behavior when advocacy, empowerment, and control over their environment is socially acceptable. Chapters 5–7 provide specific procedural detail on strategies that can be used in implementing the framework described in this chapter for behaviors that are maintained by escape from demands. Interventionists can often anticipate situations that are likely to be associated with problem behavior. Thus, many of the intervention strategies that we describe (both strategies to enhance self-­ regulation and empowering socially acceptable communication) can be implemented prior to the learner using problem behavior that serves a negative reinforcement social function (see Chapter 4). In our experience, when we begin teaching learners communicative alternatives to problem behavior, there is sometimes a tendency for them to “overgeneralize” the new alternative to other situations at the expense of self-­regulation. As a result, it is important to consider instructional strategies (e.g., signaling that a request will be reinforced via the presentation of a visual stimulus such as a word card) that address the possibility of overgeneralization. In the sections that follow, we discuss an overarching logic for instruction that seeks to maximize desired generalized use of newly established communicative behavior, while minimizing generalization errors of newly acquired behavior. When both of these objectives are achieved, learners are successful in the conditional use of newly established communicative behavior.

Classes of Intervention Strategies That Must Be Jointly Considered in Addressing a Balance between Self‑Regulation and Empowerment In Chapter 1, we described the value of communicative alternatives as an intervention strategy for persons who engage in problem behavior. The importance of this strategy is evidenced by the number of articles (e.g.,

An Integrative Model 33

Tiger et al., 2008) and most of this book’s chapters are devoted to it. However, there are other intervention tools that, when combined with communicative alternatives, enhance the balance between self-­regulation and empowerment that we have been discussing. Below, we briefly outline those areas.

Antecedent‑Focused Intervention Strategies The label antecedent-­focused intervention refers to an intervention strategy that can be implemented prior to the emission of problem behavior in situations associated with problem behavior when a communicative alternative is not an option. As with communicative alternatives, these intervention strategies require a careful linkage to assessment outcomes. Our goal is that interventionists can create a context to implement intervention that minimizes the learner’s motivation to produce problem behavior. When interventionists are successful in doing this, the likelihood that others in the learner’s environment (including the interventionist) will be the recipients of problem behavior is greatly diminished. When interventionists are less apprehensive about being the recipient of a learner’s problem behavior, the likelihood that intervention adherence (sustaining the implementation of the intervention over time) and fidelity (accurately implementing the intervention) may improve (Johnson, Reichle, & Monn, 2009). Carefully implementing an antecedent-­focused intervention strategy may decrease the likelihood for a chain of increasingly severe problem behaviors to develop that incorporates appropriate communicative behavior. Chains of escalating problem behaviors can disrupt FCT interventions because a problem behavior earlier in the chain may serve as a prompt for a care provider to create an opportunity for the learner to produce a more acceptable communicative alternative that is reinforced. The end result is that the chain of behaviors, including the most severe problem behaviors, is reinforced because all of the behaviors are in the same response class (Mace et al., 2010). Assume that a learner wishes to leave or escape an activity (e.g., restaurant, mall). First, the learner may begin to fuss and whine, followed by crying. At that point, the parent directs the child to “Use your nice words.” The child follows the direction with “Go.” The parent tells the child, “Because you asked nicely, we will go,” and then they leave. The parent feels good about this situation because a severe tantrum did not occur.

Although reinforcing the communicative alternative to problem behavior is desirable in this episode, from the child’s perspective, the crying may

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also have been reinforced because it led to the reinforcing outcome, and tantrums are similarly strengthened because they are highly correlated with crying. If the episode repeats itself, even stronger or more persistent chains of behavior will be reinforced and strengthened. In this case, an option to consider would be to start with small episodes in the community. Assume that the learner is most often OK for 15 minutes in the community. Prior to the learner engaging in escape-­maintained behavior, offer at minute 13: “In 2 minutes, we’ll go.” This delay signal creates the discriminative stimulus (SD), which communicates to the learner that contingent on a brief time with no challenging behavior, the learner will be released. This increases the probability of the reinforcement of desired behavior. Eventually, in this example, at the end of the pause between the delay signal and a release signal (e.g., “Let’s go”), the learner could be prompted to request a communicative alternative, and thus we have combined FCT with an antecedent intervention that involved fading. The available evidence base is replete with literature on fading instructional prompts (see Miltenberger, 2011). In demand fading, the demand for engagement (duration or number of task steps completed) during an activity is gradually increased. Piazza, Moes, and Fisher (1996) and later, Luiselli, Kane, Treml, and Young (2000), demonstrated the effectiveness of this procedure. In working with a 3-yearold child with multiple medical disorders and chronic food refusal, Luiselli implemented an antecedent approach that included visual cueing of a criterion number of self-­feeding responses prior to delivering reinforcement, and a gradual increase in the imposed criterion (demand fading) that was based on improved frequency of oral consumption. As a result, the child learned to feed himself. (In Chapter 4, we provide more extensive procedural detail on this strategy.) Implementing antecedent-­focused interventions in more inclusive educational settings has the potential advantage of minimizing the learner producing undesirable behavior for other children to observe and perhaps learn through imitation. Our experience has been that a frequent concern raised by parents of typically developing children is that their child will learn “bad habits” from children with problem behavior who may be part of their child’s class. A possible outcome of incorporating antecedent-­ focused intervention strategies into a behavior support plan is that there is a decreased probability of engaging in problem behavior. This, in turn, will result in peers seeing fewer problem behavior episodes. It is possible that peers and educators observing fewer behavior episodes may reduce the stigma that accompanies seeing learners repeatedly engage in problem behavior. With greatly diminished instances of problem behavior, the concern that other parents may have about their child, including being injured by a child who has a history of aggressive behavior, is addressed.

An Integrative Model 35

We now describe some examples of situations that require enhancement of self-­regulation and how these examples can be addressed in conjunction with communicative alternatives to challenging behavior. Subsequently, the remaining chapters in this book provide detailed procedures to establish these two complementary classes of strategies. An antecedent‑focused intervention (that may also involve the delivery of a consequence) implemented concurrently with a communicative alternative to problem behavior

John can use a spoken “No thanks” to preempt the delivery of asparagus at mealtime. However, when taking medication, an antecedent-­based strategy such as prespecifying a reinforcer that will be available after medication may represent a superior intervention strategy. By implementing an antecedent-­ focused strategy plus reinforcement associated with taking medication and an intervention strategy that involves a communicative alternative to problem behavior during mealtime, it may be easier to teach John to use his new communicative alternative more conditionally. For example, assume that when first taught to say “No thanks” at meals, a word card was always present that said “Your choice.” Whenever the word card was present, saying “No thanks” was reinforced by removing the nonpreferred food. However, if the word card was not present and John said “No thanks,” the interventionist said “You need to eat one piece, and then you will be finished.” This intervention was begun with neutral foods, foods he sometimes ate, to teach him to discriminate when saying “No thanks” would and would not be reinforced. In this way, John learned that he sometimes needed to comply first before he could ask to be finished. As described by Wacker et al. (2011), complying produced the word card, and appropriate behavior produced the reinforcement. When John was taking medication, the same two-step chain occurred: He first took his medication, and then he could say “No thanks” as other nonpreferred activities were presented, or “Thanks” to offered preferred activities. An antecedent‑focused intervention implemented subsequent to a communicative alternative to problem behavior

After teaching John to “request a break,” his interventionist noticed that he was using it with increasing frequency and getting less work done. His interventionist implemented a timer that was set at just slightly greater engagement than his shortest interval of work prior to requesting a break. Just prior to reaching that point, she said, “Just a little more.” After a short interval passed, John was prompted and then immediately reinforced for using his break request. Across successful episodes, the length of his engagement was systematically increased.

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An antecedent approach to intervention can focus on either the signals (e.g., SDs) that guide and prompt behavior as described above, or the MOs, described below, that temporarily increase or decrease the motivation to engage in specific responses. An example of how MOs can influence displays of problem behavior was provided by Gardner, Wacker, and Boelter (2009). These investigators first conducted a functional analysis of noncompliant behavior by young children and showed that it was maintained by negative reinforcement in the form of escape from demands. However, when demands were presented by an interventionist who displayed high-­quality attention, the children not only complied with demands but also chose to work on those same demands rather than to play alone, as long as demands were paired with high-­quality attention. Similar findings were reported by Harding, Wacker, Berg, Winborn-­Kemmerer, Lee, et al. (2009). The results of these studies and others show that we can sometimes reduce the motivation to display problem behavior by altering the task (e.g., reducing difficulty; Cooper et al., 1992) or altering the way it is presented (e.g., high-­quality attention). Altering a task to make it more preferred can be the first step in an FCT program. Initially, the task is altered. Once desired behavior is occurring, the interventionist can then teach the learner to appropriately request the altered task. When the learner is making those requests, slowly fade in the task itself, and signal when it can be changed, how much needs to be done before it can be changed, and so forth.

Communicative Alternatives to Problem Behavior Communicative alternatives to problem behavior represent another key intervention strategy. When combined with an antecedent-­focused strategy, they serve to equally enhance self-­regulatory and communicative skills as alternatives to problem behavior. An antecedent‑focused intervention implemented prior to a communicative alternative to problem behavior

With John, another option that his interventionist could have considered would have been to determine the amount of time that he tended to engage in an activity prior to engaging in problem behavior. Just after that point, insert a delay cue (e.g., saying, “Only 1 more minute,” as a timer was set). At the end of the minute, John could be released; the timer could be set increasingly longer across opportunities. Once a bit more engagement without challenging behavior had been successfully established, he could be taught to request a break.

An Integrative Model 37 A communicative alternative implemented during an activity not associated with problem behavior in order to facilitate implementation in a context associated with problem behavior

In some cases, it may be easier to teach a new communicative alternative to problem behavior in a situation that does not have a history of being associated with problem behavior. The advantage may be twofold. First, with no history of problem behavior, it is less likely that a chain of behavior involving the problem behavior would be established during acquisition. Second, the new communicative alternative should be easier to prompt in that the interventionist does not have to deal with problem behavior. A context that is not associated with problem behavior for a child might be at playtime when more paper is offered for coloring and when he or she is satiated on the coloring activity. In this situation, a child might be taught to shake his or her head “no” to indicate that no more paper is desired. Although the interventionist might choose to teach the communicative alternative concurrently in this situation with situations associated with problem behavior, we believe that when possible, a sequential implementation might be most efficient. In a sequential implementation, after establishing the generalized use of the new communicative alternative, the interventionist could begin applying the intervention to the event associated with problem behavior. First, by increasing the “fluency” of the form of the new communicative alternative, the interventionist lessens the probability of establishing a chain of behavior that involves problem behavior being produced prior to the interventionist’s prompt of the communicative alternative. Second, this strategy may facilitate quicker acquisition of the communicative alternative in a situation that is associated with problem behavior. Third, as suggested by Mace et al. (2010), teaching communicative alternatives in a different context may reduce the resurgence of problem behavior.

Two types of generalization are being addressed via general case instruction. The first type, as mentioned earlier, is stimulus generalization, which occurs when the same communicative alternative response is emitted in other situations. For example, Wacker et al. (2005) conducted FCT with young children in their homes. The child’s mother was most often the adult implementing FCT, which occurred most often in the living room of the home and involved completing demands such as stacking blocks. The three relevant types of stimulus generalization were across people (e.g., grandmother, teacher), setting (e.g., grandmother’s house, school), and tasks (different demands, such as toothbrushing). All children were taught to complete a small task, which produced a word card and a microswitch, and then to communicate with the card or switch to request a break to

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play. When each child was independent in both task completion and manding, and problem behavior was decreased by at least 90%, the generalized effects of intervention were probed across all situations. Generalization occurred for most children and in most stimulus situations, but even when it did not occur right away, very little additional intervention was needed before the child was again independent in both task completion and manding. A substantial reduction in training time is also a measure of generalization (Stokes & Baer, 1977), and so successful stimulus generalization almost always occurred with FCT. The second type of generalization, response generalization, can prove to be especially problematic during maintenance. As mentioned earlier, training the relevant communication alternative in the same context in which problem behavior occurs may inadvertently strengthen the problem behavior (Mace et al., 2010). This is because the new communicative behavior may be highly correlated with problem behavior and they, therefore, often reoccur, sometimes as part of a chain and sometimes concurrently. Thus, the reinforcement provided during FCT to teach or to strengthen the desired communication may inadvertently also “spill over” to reinforce problem behavior and response generalization may occur. Wacker et al. (2011) showed that this unwanted response generalization often occurred with FCT. Eight young children diagnosed with autism received FCT in their homes, by their mothers, and with tasks that had historically occasioned problem behavior. All eight children quickly learned to comply and then to press a microswitch to take breaks, but also quickly resumed engaging in problem behavior when their requests for breaks were not reinforced immediately. Months of treatment were often required before the effects of treatment (persistence of desired behavior and lack of resurgence of problem behavior) were maintained for even 5 minutes when manding for breaks was not reinforced immediately. The maintenance of problem behavior associated with response generalization and DRA interventions such as FCT have led researchers like Mace et al. (2010) to suggest that intervention be conducted in a twostep fashion. Training is conducted initially in an unrelated context such as play when desired communication is occurring independently and then generalized to the relevant context. This type of stimulus generalization may be much easier to conduct than having to deal with the resurgence of problem behavior. As we mentioned previously in this chapter, teaching the new communicative response in a context not associated with problem behavior prior to doing so in situations associated with problem behavior may decrease the probability of the communicative alternative from being directly associated with problem behavior. If this association occurs, problem behavior and the new communicative alternative may become part of the same response class, which will decrease the likelihood of decelerating

An Integrative Model 39

the problem behavior. Thus, we strongly recommend that teaching alternative communicative responses be conducted sequentially.

Consequence‑Related Intervention Strategies Thus far, we have not extensively discussed consequences that are often used as part of a support plan for positive behavior. Consequence-­related intervention strategies come into play in a number of ways during FCT. Bambara and Kern (2005) concluded that reactions to problem behavior can operate in several ways, including an effort to (1) reduce desirable outcomes for behavior (that facilitate the acquisition of more socially acceptable alternatives), (2) prevent the escalation of problem behavior, or (3) provide natural consequences. We briefly describe examples of these reactions.

Reducing Desirable Outcomes for Problem Behavior Wacker and colleagues (1990) demonstrated that implementation of FCT can be enhanced when there is a consequence placed on challenging behavior that represents an effort to decrease the efficiency of the problem behavior. For example, when socially maintained problem behavior was placed on extinction and a communicative alternative was reinforced concurrently, acquisition of the communicative alternative was more rapidly acquired than during a condition in which there was not an organized extinction condition implemented. Thus, incorporating a consequence-­based intervention for problem behavior into the procedures to teach a communicative alternative can enhance the learner’s ability to learn the relative efficiency of socially acceptable communicative behavior. This is because the efficiency of the problem behavior is diminished (i.e., the relationship between the problem behavior and its reinforcement is diminished), while the efficiency of the communicative alternative is maximized. That creates a con‑ trast, which enhances the discriminability between the two options. The need for a separate consequence for problem behavior was made clear when one of the authors worked as a behavior therapist on an inpatient unit for children who displayed severe problem behavior. One of the children engaged in severe pinching that left bruises. Pinching was maintained by access to toys. This child would often walk up to the interventionist, pinch him, and then sign “please” to get more toys. The two-step chain of pinching and signing needed to be disrupted. This was easily accomplished by removing the toys for 30–60 seconds following pinching and reinforcing mands only when the child was signaled by a word card that said “toys.” Both the card and the toys were briefly unavailable following pinching, and the child quickly learned not to pinch and then sign. Punishment does not need to be severe, as shown in the example above,

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FUNCTIONAL COMMUNICATION TRAINING FOR PROBLEM BEHAVIOR

and can often improve the speed with which FCT reduces problem behavior (Hagopian et al., 1998).

Preventing the Escalation of Problem Behavior Consequence procedures may be necessary as part of an emergency procedure to stop a problem behavior from continuing to occur. For example, when a learner attempts to run into oncoming traffic, a reaction to this problem behavior must be to get it to stop quickly. Consequently, physical redirection and temporary restraint may be required to keep the learner and/or others safe. Note that this is not an application that should be used on a long-term basis as part of a support plan. It should be viewed as more of an emergency procedure. It is important to monitor the use of this type of procedure to ensure that the frequency of its use is not increasing, and it should be monitored by experts in applied behavior analysis.

Providing Natural Consequences Extinction is a good example of a natural consequence for socially unacceptable behavior. For example, if an obnoxious individual engages in repeated attempts to attract one’s attention, ignoring him or her is a natural consequence that is apt to be used by the general public. It is important for individuals to learn that when someone ignores their behavior, they are withdrawing reinforcement for engagement in the behavior. Most of us learn to “read” ignoring as a cue that we have engaged in behavior that is not pleasing to social partners and should alter our behavior. Spoken language such as “I don’t like that” or “Would you please stop?” can also be examples of negative and corrective feedback that members of society use to influence our behavior, but we need to be cautious that these consequences are not provided for attention-­maintained problem behavior.

A Warning about the Exclusive Use of Punishment Procedures There are a number of disadvantages that have been associated with the exclusive use of procedures that serve to punish behavior. Our views on punishment are summarized in Wacker, Harding, Berg, Cooper-­Brown, and Barretto (2009). Punishment can have some unintended consequences, such as avoidance of the interventionist. If used exclusively, it does not teach desired behavior. This is why punishment should be used only in combination with a DRA program such as FCT. We further suggest that if punishment becomes a major component of the FCT program, then consultation should be obtained from a qualified applied behavior analyst who can not only assist in developing the program but also in developing monitoring and

An Integrative Model 41

fading plans. In addition to consequences that can be placed contingent on the emission of problem behavior, the delivery of consequences for desired behavior represents an important component of any behavior support plan.

Reinforcement for Desired Behavior Noncontingent Reinforcement Often in the business of our lives, we come to take desirable behavior for granted. As a result, while undesired behavior may be very apt to receive a consequence, such as attention, desired behavior is often not reinforced to the extent that we would like to see. We know that this balance between reinforcing desired behavior versus reducing undesirable behavior is very important. However, it can be difficult to provide more attention or higher-­ quality attention for desired behavior if it rarely occurs and if problem behavior occurs at a high rate. In this case, we often consider implementing response-­independent noncontingent reinforcement (NCR) to decelerate problem behavior. As an example, we worked with an adult with an autism spectrum disorder who engaged in elopement between 500 and 700 times per week. A functional analysis revealed that the behavior was attention maintained and that he attempted leave if he did not receive attention approximately every several minutes. The intervention consisted of NCR that involved putting him on a schedule of attention, or check-ins, by staff approximately every 4 minutes. Within several months, his elopements had decreased to fewer than 10 per week. Most of the remaining elopements involved the learner going to the door and lingering (which we believe acted as a request for attention). A reasonable follow-­up plan that could have been implemented concurrently with the noncontingent attention is to teach him a socially acceptable strategy to recruit attention. The effectiveness of NCR as a treatment for problem behavior has been demonstrated by several investigators (Fischer, Iwata, & Mazaleski, 1997; Hagopian, Fisher, & Legacy, 1994; Mace & Lalli, 1991; Vollmer, Iwata, Zarcone, Smith, & Mazaleski, 1993; Vollmer, Marcus, Ringdahl, & Roane, 1995). NCR may result in success because it weakens the response–­reinforcer relationship in that it provides reinforcement that is independent of the individual’s behavior. The use of this procedure may decrease the individual’s motivation to emit problem behavior to gain access to the reinforcer because the reinforcer is more often available. NCR has potential benefits. First, it ensures consistent rates of reinforcement by providing the reinforcer independent of behavior. Additionally, previous studies have shown that NCR may help to avoid extinction bursts (e.g., Hagopian et al., 1994; Vollmer et al., 1995). Finally, NCR is relatively easy to use in that its delivery is time based rather than based on

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learner performance. Although it may have most often been implemented with problem behavior maintained by attention, NCR has been demonstrated to be effective with a variety of socially maintained problem behavior (Hagopian et al., 1994; Marcus & Vollmer, 1996; Vollmer et al., 1995).

Contingent Reinforcement for Desired Behavior Of course, contingent reinforcement for desired behavior is also very important. It comes into play in establishing antecedent-­focused and communicative alternatives to problem behavior. As we discussed in earlier chapters, there are both positive and negative classes of reinforcers. It is very important that these be identified prior to any intervention. In many instances, reinforcement value must be particularly strong during acquisition procedures. In many cases, the reinforcers to be used in FCT programs are clear. The learner clearly and consistently indicates via words, pictures, or gestures that he or she wants a specific item or activity. In other cases, the results of the functional analysis clearly identify the reinforcer-­maintaining problem behavior and that becomes the reinforcer used to reinforce appropriate communication (e.g., a “break”). However, as discussed in Chapter 2, even when the function of problem behavior has been identified, the specific item or activity that will function best as the positive reinforcer may still need to be identified. For example, if the function of problem behavior is to escape from nonpreferred demands, and breaks from those demands are used as the reinforcer, we still must identify what to provide to the learner during the breaks. As shown by Golonka, Wacker, Berg, Derby, and Peck (2000), breaks that are enriched (i.e., contain positive reinforcers) are often preferred to breaks alone, and can function as more potent reinforcers. Other researches (e.g., Gardner, Wacker, & Boelter, 2009) have shown that the presence of positive reinforcers can abolish the individual’s motivation (i.e., can alter the MOs associated with negative reinforcement) to escape a task. Gardner et al. showed that children whose problem behavior was identified to be maintained by escape from a task actually chose to complete the same task when it was paired with high-­quality attention from an adult. Thus, FCT programs for behaviors maintained by either positive or negative reinforcement frequently require that positive reinforcers be provided following the display of an alternative communicative response.

Identifying Reinforcers Identifying positive reinforcers is a two-step process. Step 1 involves the completion of a preference assessment, and step 2 involves the demonstration that the identified, preferred stimulus functions as a reinforcer (Fisher

An Integrative Model 43

et al., 1992). Once preferred stimuli have been identified, a reinforcer assessment is conducted by making access to the preferred stimulus contingent on the learner emitting a response such as a mand. There are many ways to assess an individual’s preferences, but there are four direct observation methods that we use most often: (1) paired stimuli (also called forced choice; Fisher et al., 1992), (2) multiple stimuli without replacement (MSWO; DeLeon & Iwata, 1996), (3) free operants (FO; Roane, Vollmer, Ringdahl, & Marcus, 1998), and (4) concurrent operants (CO; Harding, Wacker, Berg, Winborn-­Kemmerer, Lee, et al., 2009). We use procedures based on direct observation because previous investigations have shown that the correspondence between care provider opinion and direct observation can be low in identifying preferred stimuli (Reid, Everson, & Green, 1999). The preference assessment procedure to use depends on several variables, which we briefly describe below, summarize in Table 3.1, and discuss in greater depth in Chapters 8 and 9. A paired stimulus procedure involves the identification of multiple items or activities that may be preferred by the learner. Every item/activity is paired against every other item and the trainer records which item is selected on each trial. Once selected, the learner can consume the stimulus (eat it or engage with it briefly) before it is removed and a new pair of stimuli are presented to the learner. This method is an excellent procedure for identifying potential reinforcers to use during FCT programs, and has the advantage of providing a hierarchy of most- to least-­preferred items. Studies have repeatedly shown that this preference hierarchy identified via TABLE 3.1.  Preference Assessment Procedures Procedure

Description

Advantages

Paired stimulus (Fisher et al., 1992)

Learner chooses between items that are presented in pairs.

Provides a definitive hierarchy of most- to leastpreferred stimuli.

Multiple stimuli without replacement (MSWO; DeLeon & Iwata, 1996)

Present items in a group and remove items as selected.

Provides a more efficient method to identify most- to least-preferred stimuli.

Free operant (FO; Roane, Vollmer, Ringdahl, & Marcus, 1998)

Present items in a group and measure engagement with item.

Identifies preferred items very quickly.

Concurrent operant (CO; Harding, Wacker, Berg, Winborn-Kemmerer, Lee, et al., 2009)

Items/activities placed in different locations that require learner to go to the location.

Provides for a competition between items/activities to identify preferred classes of reinforcement.

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the paired stimulus procedure is strongly related to reinforcing stimuli—­ that is, highly preferred items (those selected at least 80% of the choice trials) often function as reinforcers. The two main drawbacks to this procedure are time and frustration. If, like Fisher et al. (1992), 16 items are being evaluated, this procedure can take a long time to complete. For this reason, when we use this procedure, we often evaluate only four to eight items. Enough items are needed to establish a clear preference hierarchy, but not so many that the procedure takes too long to complete. Although it is tempting to assess preferences only once at the beginning of an intervention, preferences are dynamic and often change frequently, necessitating that preference assessments be repeated frequently. We suggest repeating the preference assessment whenever the effectiveness of FCT is diminishing or if the learner is not consuming the reinforcer. By consuming, we mean that the learner is not eating/drinking food items, not playing with tangibles, or not interacting with others. The absence of consumption strongly suggests that a change of preference has occurred and the preferred item/ activity is no longer reinforcing. If it is possible to assess preferences often to avoid this situation, that is ideal, but if that cannot be done, make sure to check preferences whenever the intervention appears not to be effective. The second problem with the paired stimulus method is that it can frustrate some learners. If, for example, a learner has a strong preference for only one item, having that item removed repeatedly can be frustrating, as can the repetition of choice trials that often involve only nonpreferred items. In addition, providing only brief access to a preferred item can upset some learners. Both the MSWO and FO procedures are more efficient, and involve presenting learners with multiple items simultaneously. In the MSWO procedure, items selected are removed until all items have been selected, with the first item being considered the most preferred item. This procedure provides a more efficient identification of the learner’s hierarchy of preferred stimuli, but because not every item is compared with every other item, the hierarchy is less definitive. In the FO procedure, learners have free access to all items for at least 5 minutes, and preference is defined by the length of time that contact is made with each item. Both the MSWO and FO procedures identify preferred stimuli that have been shown to function as reinforcers, and both are more efficient than the paired stimuli procedure. The relative advantage of the MSWO procedure is that it allows the identification of a preference hierarchy, which may be important if the learner quickly satiates on even the most preferred items. The MSWO allows the person to know which other items that are lower in the hierarchy can be substituted for the relatively more preferred stimuli. The FO procedure can take only 5 minutes to complete (Roane, Vollmer, Ringdahl, & Marcus, 1998) and thus can be

An Integrative Model 45

conducted prior to every FCT session. We try to begin every FCT session with a 5- to 10-minute period of free play, and during free play we measure preference with the FO procedure. However, it is important to note that using this procedure can be challenging with a learner who plays only with one item. For those children, it may be important to consider other strategies. The CO procedure provides a good way to measure preference for classes of reinforcement. For example, Harding, Wacker, Berg, Winborn-­ Kemmerer, & Lee (2009) evaluated learners who had problem behavior maintained by escape from demands. Following the completion of the functional analysis, Harding, Wacker, Berg, Winborn-­Kemmerer, & Lee (2009) paired the nonpreferred demands with either positive adult attention or a preferred item. This was accomplished by setting up two sides of the room. On one side was the nonpreferred demand with a parent, a preferred toy, or both present, and on the other side, nothing at all. The learner could choose to escape the demand by going to the alone side, but would have to give up attention and toys. Or, the learner could go to the demand side, complete a small portion of the task (which increased across sessions via demand fading), and then receive access to the toys and/or attention. The child was free to move back and forth between the areas—that is, he or she could choose which reinforcers to consume during the entire 5-minute session. The results showed that positive reinforcement can often compete effectively with negative reinforcement, with the learner actively choosing to complete nonpreferred demands to obtain the positive reinforcers. We recommend that this procedure be considered whenever a learner is displaying behavior maintained by escape from demands. If the first phase of intervention is devoted to evaluating the relative strength of positive reinforcement versus negative reinforcement, then the interventionist can determine how to best enrich breaks from demands to make those breaks more reinforcing, or may even abolish the learner’s motivation to escape the demand as shown by Harding, Wacker, Berg, Winborn-­Kemmerer, & Lee (2009). If the motivation to escape is abolished, then there is nothing further that is needed to establish an effective intervention. However, for most learners, the intervention continues to be the two-step model of completing a small amount of work before requesting an enriched break (e.g., Wacker et al., 2011). Thus far, we have introduced a range of intervention strategies that include communicative alternatives to problem behavior, antecedent-­ focused interventions, and consequences for both desired and undesired behaviors. It is common that each of these groupings is coordinated together in the development and implementation of a plan to support an individual who engages in problem behavior. As mentioned earlier in this chapter, it is important to make it as clear as possible to the learner the

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circumstances in which newly established positive behavior will and will not be reinforced. In those situations where it cannot be reinforced, it is important to have an alternative support strategy implemented. For us, a general case instructional framework provides a way to think about operationalizing this implementation strategy and is the focus of our discussion for much of the remainder of this chapter.

An Integrated Implementation of Multicomponent Intervention for Problem Behavior That Includes Antecedent‑Focused, Communicative Alternative, and Consequence‑Based Intervention Components Several years ago, we worked with Alfonso, a second grader who experienced a moderate intellectual delay. His teacher and mother reported that Alfonso engaged in tantrums that were believed to be associated with escape that was maintained by a variety of events at school and at home. A structured descriptive analysis combined with a functional analysis revealed that Alfonso escaped academic events that he was not yet capable of performing independently. Additionally, he escaped tasks that, from his perspective, lasted too long. To address escape-­maintained tantrums, two communicative alternatives were implemented. To address the difficult tasks, an intervention strategy to teach an assistance request was implemented (Chapter 6 describes implementation of this program in detail). This program required introducing opportunities where the new assistance request could be reinforced when used. It also required ensuring that there were instructional opportunities where Alfonso should refrain from attempting to use a request for assistance and instead complete his work. Initially, care was taken to provide adequate prompts to ensure success with the new assistance requests. As soon as a request was made, Alfonso was provided with generous assistance. This resulted in the task being completed quickly with frustration minimized. Across instructional opportunities, prompts to produce an assistance request were gradually reduced (faded). At the same time, the level of assistance with the task was faded as Alfonso became increasingly competent. Once he was independently taking advantage of a high proportion of opportunities with difficult work to request assistance, the interventionist implemented an antecedent-­focused intervention strategy to encourage moderation in the use of the assistance request. A greater quantity of reinforcement was made available for work that Alfonso completed independently and correctly. A lesser reinforcement quantity continued to be made available after the completion of work that required an assistance request (in Chapter 4, we discuss this procedure as a competing schedule of reinforcement). Whenever Alfonso engaged in a tantrum during an activity, the interventionist continued to work with him, ignoring the tantrum (and not allowing escape from the

An Integrative Model 47

activity). By combining these procedures, Alfonso learned to request assistance when needed and to refrain from requesting assistance when it is not needed. He also learned that either requesting assistance or working independently were the most efficient strategies to gain escape or negative reinforcement from academic work. In the case of tasks that from Alfonso’s point of view continued too long, his intervention team chose to implement an intervention strategy to teach break requests as a communicative alternative to escape maintained tantrums. They implemented the instructional procedures outlined in Chapter 7. The antecedent-­focused intervention component included a procedure called tolerance for delay in the delivery of reinforcement (TFD). In this procedure, the interventionist determines a conservative degree of engagement that typically occurs without the learner finding it necessary to engage in problem behavior. This is the initial expectation for the length or amount of engagement that will occur prior to the delivery of a break. Over time, the length of engagement is systematically increased using procedures described in Chapter 4 and reiterated in Chapter 7. Another component of this program was the same as it was during opportunities to request assistance in that if Alfonso emitted a tantrum, the task continued and he was not allowed to escape task demands. A final component of Alfonso’s intervention support included considering environmental events that might contribute to his agitation. Excessive classroom noise and peers walking by him to wash their hands at a sink near his desk often resulted in Alfonso disengaging from tasks to watch. To minimize this as an MO, Alfonso was provided with an opportunity to select a new spot in his classroom. He chose a spot as far away from the sink as was possible.

The instructional example we have described in working with Alfonso provides a brief illustration of the importance of combining separate antecedent-­focused, communicative alternative, and consequential strategies in designing instruction. We believe that this approach affords the most efficient means of quickly decelerating problem behavior that reinforces escape, attention, and/or tangible maintaining events. Note that each of the strategies we have described in this example are discussed in extensive detail in the chapter(s) noted.

The Role of General Case Logic in Implementing a Comprehensive Behavior Support Program As we discussed at the beginning of this chapter, intervention strategies that focus concurrently on communicative alternatives to problem behavior (including its corresponding consequential strategies) and antecedent-­ focused intervention strategies to enhance self-­regulatory skills may be best

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implemented by considering general case logic (Horner et al., 1986). Originally, general case instruction was conceived of as an instructional framework designed to increase both well-­discriminated and well-­generalized use of newly established behavior. When this occurs, conditional use of newly taught behavior is likely. In general case instruction, the interventionist identifies the skill to be taught (e.g., teaching requests for a break, or in the case of antecedent-­ focused interventions, teaching the learner to increase sustained engagement in an activity). Next, the interventionist considers the range of situations in which using the new behavior would be desirable. Simultaneously, he or she considers the range of possible situations in which inappropriate uses of the behavior might occur. From these two sets of plausible situations, an interventionist selects both positive and negative teaching examples. Positive teaching examples are selected that sample the range of different stimulus features that should be associated with use of the behavior. For example, in requesting apples, it might be important to consider utilizing red, yellow, and green ones during intervention. Correspondingly, the interventionist would identify negative teaching examples, which are teaching opportunities that sample the full range of characteristics that should be associated with not engaging in the behavior to be taught. For example, in some settings, it would be inappropriate to request access to a TV show or computer game. When both positive and negative teaching examples have been well identified and both taught concurrently, appropriate generalization is enhanced, while the probability of inappropriate generalization of the new behavior is decreased. Establishing an appropriate balance between discriminating “when to use” and “when not to use” a newly taught behavior (regardless of the type of intervention being implemented) represents a particularly important area that to date has been underrepresented in evidence-­based literature. A number of studies have been successful in implementing communicative alternatives to problem behavior (see Carr et al., 1994; Casey & Merical, 2006; Derby et al., 1997; Dunlap & Fox, 1999; Durand, 1990; Durand & Carr, 1992; Olive, Lang, & Davis, 2008; Schindler & Horner, 2005; Wacker, Harding, et al., 1996, and a plethora of others). A comparable or perhaps greater number of studies have demonstrated the efficacy of procedures to enhance a learner’s self-­regulatory skills when a communicative alternative cannot be reinforced. (See Chapter 4 for citations of evidence-­based interventions to enhance self-­regulatory skills.) We believe that both of the situations just described require the interventionist to consider a package of intervention procedures. However, to date, relatively few investigations have attempted to concurrently implement both communicative alternatives and self-­regulation enhancement strategies with the goal

An Integrative Model 49

of enhancing an individual’s skill in self-­empowerment while enhancing self-­regulatory skills.

Examples of Establishing Conditional Use of Newly Established Behavior Few studies have fully implemented a general case instructional framework in implementing behavioral support for persons with problem behavior, as outlined in Table 3.2. However, several investigators have implemented procedures to establish conditional use of communicative alternatives to problem behavior. Reichle and Johnston (1999) manipulated the proximity of food items so that “near” items should be directly taken by learners (serve oneself) without a request, but “far” items should be requested. Two elementary-­age children who were nonverbal participated. Using an AB design with single replication across learners, the baseline phase (A) was followed by an intervention phase (B), teaching self-­ selecting and requesting contingent on the proximity of desired items to the participant. Rapid acquisition of conditional requesting resulted in a collateral decrease in problem behavior that was associated with taking peers’ snack items. Reichle and McComas (2004) taught the conditional use of assistance requests as an alternative to escape motivated problem behaviors to a 12-year-old boy with behavior disorders who produced a variety of pragmatic functions using speech. Teaching-­assistance requests were paired TABLE 3.2.  General Case Instruction Procedures Step

Description

1. Identify the instructional environment.

Identify the relevant stimulus features that should serve as discriminative stimuli for the individual to request assistance or refrain from requesting assistance.

2. Identify teaching examples.

Positive and negative teaching examples should be identified. The examples should sample the range of stimulus conditions identified in the previous step.

3. Sequence and teach the selected examples.

Selected teaching examples should be sequenced moving from highly discriminable stimuli to less discriminable. Teaching opportunities may be embedded within the individual’s daily routine.

4. Test for generalization with probes.

Probes should be administered during the intervention to confirm whether the instructional procedures were effective.

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with escape extinction for problem behavior. As a result of intervention, assistance requests increased and problem behaviors decreased. Independent solutions to problems increased only after a competing schedule of reinforcement was implemented. Once a request for assistance was established, the learner used it independently and at a steady frequency during tasks that had been utilized during acquisition. However, the authors hypothesized that the learner should have become increasingly more independent as a function of the prompts and prompt fading subsequent to an assistance request that had been implemented. Instead, independent responding did not increase, and there was no moderation in assistance requests emissions. Subsequently, the interventionists established work that consisted of a mix of easier and more difficult problems to solve. The easier problems were ones that, originally, had been the focus of assistance requests that the learner had been observed to perform independently when specifically told that no assistance was available. Difficult problems were ones that the teacher judged to be above the learner’s level of performance and ones that the boy had not previously provided evidence of solving independently. The learner was told that if he could “figure out” which ones should be the focus of his assistance requests and which ones should not be the focus of assistance requests and act accordingly, he would receive a high-value reinforcer that he had chosen prior to the onset of the activity. With an appropriate reinforcer in place, the learner demonstrated that he could conditionally use his newly acquired assistance request.

Summary To ensure that interventionists can address a full range of situations associated with problem behavior for a particular learner, we believe that with most socially maintained problem behavior, the positive behavior support plan must include a “multicomponent” package of support strategies that includes a full range of intervention strategies. However, to describe all available evidence-­ based antecedent-­ focused intervention strategies goes well beyond the scope of this book. In the next chapter, we focus on providing examples of some antecedent-­focused strategies that we have successfully implemented with learners who experience socially maintained problem behavior. Each strategy is described along with an example of its implementation. Following our discussion of some antecedent-­focused interventions, we turn our focus to chapters that describe teaching alternative behavior to address problem behavior.

Chapter 4

Examples of Antecedent‑Focused Intervention Strategies

In this chapter, we describe a variety of antecedent-­focused intervention

strategies that were introduced in the preceding chapter. Antecedent-­ focused strategies are implemented in situations that have been associated with problem behavior and are identified from the results of a functional behavior assessment. As stated in the preceding chapter, the goal of antecedent-­focused strategies is to implement an intervention(s) in activities that have been demonstrated to be associated with problem behavior before the learner produces problem behavior. Antecedent-­ based interventions seek to modify an aspect of the (1) setting, (2) activity, (3) materials used in the activity, or (4) actions of the interventionist. After teaching Juan to “request a break,” his interventionist noticed that he is using it with increasing frequency and getting less work done. His interventionist may implement a timer that is set at just slightly greater engagement than his shortest interval of work prior to requesting a break. Just prior to reaching that point she says, “Just a little more,” the short interval passes, and Juan is then reinforced for engagement by being told that he can now request a break. Doing so results in access to a desirable break.

In this example, Juan learns that engaging in a brief amount of more work can also result in obtaining a break. As mentioned in the previous chapter, antecedent-­focused strategies seek to either teach the interventionist 51

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to modify an MO that may influence the probability of problem behavior, or they represent an effort to teach the learner to better self- regulate his or her behavior. One of the advantages of antecedent-­focused intervention strategies is that they are implemented prior to the emission of problem behavior. Consequently, they may help to prevent the learner’s motivation to engage in problem behavior. Even when we are implementing a communicative alternative to problem behavior, it may be possible to focus on strategies that enhance the probability of delivering intervention in the absence of problem behavior. For example, as discussed previously in Chapter 3, a prospective approach is to teach a communicative alternative during situations in which there is no (or a lower) probability of problem behavior prior to introducing it in the context of problem behavior. This may make it easier for the learner to produce it in a situation associated with problem behavior as a result of prior acquisition. Even if it is not fully acquired, it may make it possible for the interventionist to be less intrusive in the delivery of a response prompt required to produce the behavior in the situation associated with problem behavior (thereby lessening the possibility for problem behavior to occur). A context that is not associated with problem behavior for a child might be at snack time when more orange juice is offered and he is satiated. In this situation, the child might be taught to shake his head “No” to avoid the delivery of an orange juice refill. Concurrently, he could be taught the same head shake to communicate the protest “No” when he is asked if he wants to play with puzzles while he is playing with a more preferred activity (again, a situation not currently associated with significant problem behavior). After establishing the generalized use of the new communicative alternative, the interventionist could begin applying the intervention in the context associated with problem behavior.

The sampling of different antecedent-­focused strategies described in this chapter (see examples in Table 4.1) can function as major components of behavior support plans. The desired outcome of these strategies is an improvement in the learner’s self-­regulation during the activity that is correlated with increased occurrences of problem behavior. The interventions are not intended as an exhaustive list but rather as examples of some frequently used strategies that alter the MOs or SDs associated with problem behavior. We have followed the suggestion of Luiselli (1998) to base these interventions on SDs and MOs that may be associated with problem behavior. Both of these types of antecedents have been studied extensively in the applied literature.

Examples of Antecedent‑Focused Intervention Strategies 53 TABLE 4.1.  Examples of Antecedent-Focused Intervention Strategies for Contexts Associated with Problem Behavior Label

Operation

Description

Signaled reinforcement

Discriminative stimuli and motivating operations

Teaches learner a tolerance for delays in reinforcement.

Demand fading

Motivating operations

Teaches learner to complete increasing amounts of work prior to having a break.

Prespecifying a competing schedule of reinforcement

Discriminative stimuli

Signals that larger or higherquality reinforcers are available for alternative responding.

Graphic organizational aids

Discriminative stimuli

Cues learner when activities will occur or participation is required/ permitted.

Motivating operations

Shows the learner when preferred stimuli will be available or nonpreferred tasks will end.

Discriminative stimuli

Teaches learner to respond to natural prompts.

Prompt fading

Implementing an Antecedent‑Focused Intervention to Address Undesired Generalization (Socially Unacceptable Overgeneralized Use of a Communicative Alternative) If a learner acquires a communicative alternative to problem behavior, it is not unreasonable to assume that he or she may attempt to use it in a variety of contexts that were not the original focus of intervention, even though each involves the production of problem behavior in an effort to obtain the same social outcome. Unfortunately, some aspects of generalization may be unintended and undesired. Assume that Raoul has learned that if he does not want green beans served on his plate, saying “No” represents an efficient behavior that is functionally equivalent to the much more effortful tantrum that was used in the past. Once “No” has been taught during activities in which he could be allowed to escape (contingent on a more socially acceptable protest), consider an example in which Raoul encountered being asked to take his seizure control medication. It would be quite possible that he would generalize his spoken word

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“No” to address his desire to escape taking the medicine. Unfortunately, this is one of those contexts in which a socially acceptable protest cannot be reinforced. As a result, his parents would face a dilemma of either ignoring his communicative request or allowing him to at least briefly escape his medication. They chose to ignore the request, which led to Raoul engaging in the other member of this response class, which unfortunately was throwing tantrums. In the preceding example, the interventionists’ were not prepared to handle situations associated with escape in which a socially acceptable communicative protest could not be reinforced.

We believe that with most socially maintained problem behavior, the positive behavior support plan almost always consists of a package that includes multiple support strategies. In the example just presented, the dilemma described can be avoided by concurrently establishing an antecedent-­focused intervention and a communicative alternative with each intervention strategy being initially associated with different contexts. Concurrently implemented intervention strategies that focus on communicative alternatives and self-­regulatory intervention strategies follow a general case logic (discussed in Chapter 3). Concurrent with contexts in which a communicative alternative could be reinforced (positive teach‑ ing examples), the interventionist could identify situations in which problem behavior currently occurs that are characterized as negative teaching examples. In these negative teaching examples, the communicative alternative cannot be reinforced. Consequently, antecedent-­based intervention(s) could be identified and implemented. Briefly, we describe some of the antecedent-­ focused intervention procedures that an interventionist may wish to consider combining with communicative alternatives to problem behavior. Next, we discuss using antecedent-­focused strategies to complement communicative alternatives to problem behavior. Subsequently, we address implementing antecedent-­focused strategies when it is not possible to establish an alternative response that serves the same communicative function as the problem behavior.

TFD in the Delivery of Reinforcement TFD is sometimes referred to as signaled delay or signaled reinforce‑ ment (see Reichle, Johnson, Monn, & Harris, 2010). The purpose of this approach is to teach the learner to delay the delivery of escape, attention, or tangible reinforcement that is maintaining problem behavior. The procedure consists of a number of components. After describing these components, we provide a brief overview of possible situations in which TFD might be implemented.

Examples of Antecedent‑Focused Intervention Strategies 55

Historically, TFD has been a prominent part of a number of intervention strategies aimed at socially motivated problem behavior (Allen, Loiben, Allen, & Stanley, 1992; Carr & Carlson, 1993; Fisher, Thompson, Hagopian, Bowman, & Krug, 2000; Hagopian, Toole, Long, Bowman, & Lieving, 2004; Hanley et al., 2001; Kemp & Carr, 1995; Kern, Carberry, & Haidara, 1997). TFD is a multielement intervention and can be implemented with each of the major social functions of problem behavior.

Identifying Components of a TFD Procedure The implementation of TFD involves (1) identifying a level of engagement prior to the emission of problem behavior to ensure that the procedure is not implemented earlier than necessary (e.g., if a learner predictably participates in math for 5 minutes prior to an escape attempt, there is no need to consider implementing an intervention procedure at the beginning of the math); (2) identifying and subsequently delivering a delay cue (or signal: e.g., holding up an index finger and saying, “We’re almost done” or “Only one more to go”); (3) monitoring the passage of time and continued engagement in the activity between the delivery of a delay signal and the actual release from the task; and (4) identifying/delivering a release signal that provides the learner with a cue that the activity has been stopped, at least temporarily. TFD results in a gradual delay in the delivery of reinforcement. With attention-­maintained problem behavior, the delay signal cues the learner that contingent on a specified amount of time without problem behavior, attention will be provided. We often use timers to signal when the wait time is over. Many learners find waiting to be very difficult, and so we often provide learners with a neutral to preferred task to complete/play with while they are waiting. To make this task even more preferred, we often keep the task away from learners (e.g., in a “treasure chest”) except for these wait periods so that they can select items from their treasure chest. When this occurs, we have altered the motivating operations (MOs) associated with waiting and, thus, waiting is no longer correlated with problem behavior. A very similar approach can be used with waiting for a preferred item or activity. Timers can signal how long the wait time will be as can a visual schedule that clearly shows when the item will be available. You can reduce the frequency with which the learner asks about the item or activity by using schedules. Having to repeatedly report when the item or activity will be available can become aversive to the care provider and a clear schedule can often reduce the overall frequency of these questions. We also often use a “safety spot.” This is a location (e.g., a marked area or drawer) where the preferred item is placed while the learner waits for it. Some learners appear to be very anxious about what has happened to an especially preferred item. They express concern about others taking

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it, or it being lost. Having a designated location that is secure where the item is always placed can reduce the learner’s requests to see the item. Some learners wait much better if they can see the item, but others do better when the item is out of sight. To determine which antecedent approach to use, conduct an antecedent analysis (e.g., Wacker, Berg, Asmus, Harding, & Cooper, 1998) to compare the learner’s behavior when the object is “in view” and when “out of sight.” Across days or times of the day, we vary in view or not in view on a randomized or counterbalanced basis (i.e., within a multielement design). We keep track of the frequency of problem behavior in each condition, which is repeated three to five times to determine whether in view is better than out of sight. We use a similar type of analysis for determining whether other antecedent variables, such as timers and visual schedules, are important components.

Implementing a TFD Procedure with Behavior Maintained by Escape To implement TFD, the interventionist must conduct a baseline to determine the level of task engagement prior to an escape attempt, or the amount of time the learner is willing to postpone the delivery of attention or a tangible consequence. The criterion for release from a task that is or has become aversive is set at or slightly below this threshold; the delay signal is delivered at the identified criterion level. During the beginning phase of intervention, the interventionist may need to implement the release signal almost immediately after the delay signal to ensure that the learner can be reinforced for a period of desired engagement. Waiting too long between delay and release signals can result in problem behavior, which then creates a dilemma for interventionists because they cannot immediately deliver reinforcement. Across instructional opportunities, the criterion for engagement prior to delivery of the delay signal can be increased systematically. Alternatively, the amount of engagement between the delay and release signals can be increased gradually and systematically. A delay signal can consist of spoken words (e.g., “Hang on”), or a visual cue such as a timer that counts down. Regardless of the communicative mode used to signal the delay, either a general or explicit delay signal can be chosen. A general delay signal does not specify precisely the degree of engagement required prior to release, just that release is forthcoming (e.g., “Hang on,” or “We’ve almost got it made”). An explicit delay signal specifies an objectively quantified criterion for continued engagement prior to task termination (e.g., “Only one more,” or “Just one more minute”). Early use of TFD in the implementation of intervention strategies in natural environments was reported by Kemp and Carr (1995), who successfully implemented a TFD procedure as part of a multicomponent intervention strategy with persons employed at a greenhouse. Several years

Examples of Antecedent‑Focused Intervention Strategies 57

earlier, Carr and Carlson (1993) implemented a TFD procedure as part of a multicomponent strategy for three persons who had severe intellectual disabilities. In this investigation, the procedure was implemented for escape attempts during community shopping. When a participant requested a preferred item, the interventionist delivered a delay cue (e.g., “First, let’s get one of the things on our shopping list, and then we’ll come back”). Participants were allowed to select the preferred item after first selecting the next item on the list. Kern et al. (1997) successfully implemented TFD with a young woman who produced self-­injurious behavior maintained by escape from tasks and aggression maintained by the delivery of food (although the procedure was less effective in decreasing aggression). Despite the somewhat limited research addressing this procedure, we suspect that TFD is a procedure that practitioners may attempt to implement fairly often. Unfortunately, it may often be implemented after rather than prior to the learner’s production of problem behavior and this may result in an inadvertent chain of reinforced problem behavior. To date, little attention has been directed at the nature of the delay cue utilized in implementing a TFD procedure. Explicit delay signals, unlike general delay signals, offer an opportunity for the learner to monitor how much more or how much longer engagement is required prior to the delivery of positive or negative reinforcement (depending on the function of the problem behavior). It is possible that an explicit delay signal provides the learner with greater predictability of the amount or duration of engagement (or waiting) prior to obtaining the desired reinforcer compared with that provided by a general delay signal. Establishing greater predictability in the implementation of components of an individual’s general routine has been shown to be a strategy that can reduce the propensity for some learners to engage in problem behavior (e.g., Eno-­Hieneman, Dunlap, & Reed, 1995; Fisher et al., 2000; Hanley et al., 2001). An example of TFD was described by Reichle et al. (2010). They compared “explicit” and “general” delay signals with two children who experienced moderate to severe intellectual delays. Mark was a 6-year-old boy diagnosed with Down syndrome and a moderate cognitive delay. Pete was a 4-year-old preschooler diagnosed with autism spectrum disorder. The following procedures were implemented. An explicit delay cue

The interventionist began each opportunity by saying, “Time to work.” This was followed immediately by an explicit delay cue of “Just do one more.” The interventionist then displayed the specific number of work units to be completed counting aloud as the learner completed each unit. During puzzle and shape matching, the interventionist visually displayed the specific number of work units to be completed by removing the designated number from clear

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plastic bags that contained all of the work units. During the picture-­pointing task, the interventionist visually displayed the specific number of work units to be completed by separating the designated number from the larger group of work units. Subsequent to a verbal and visual explicit delay cue, each instructional opportunity ended contingent on completion of the work specified in the delay cue and reinforcers were provided. No reinforcement was available during unsuccessful opportunities. A general delay cue

The interventionist began each opportunity by saying, “Time to work,” immediately followed by the spoken general delay cue, “Almost done.” Simultaneously, the interventionist displayed a visual general delay cue (Mayer–­ Johnson symbol representing ‘wait’). The expectations for work prior to the delivery of the release cue were identical to the criterion for work completed prior to the delivery of a release cue during the explicit delay condition. Reinforcement contingencies were the same as they were during the explicit delay condition” (Reichle et al., 2010, p. 714).

The procedural package that comprises TFD is often used in combination with extinction and demand fading (which was the case in Reichle et al., 2010). Consequently, we describe each of the components that are typically part of the procedure.

Procedures Common to Both General and Explicit Delays Extinction In Reichle et al. (2010), the participants’ escape attempts were impeded during intervention. If a learner attempted to leave an activity, escape was made more difficult. In this study, the learner’s desk was placed in the corner; if the learner left the activity, the interventionist did not allow access to preferred activities. Additionally, the interventionist took the activity to wherever the learner moved in the classroom and physically prompted engagement. Note that unless used with other procedural components, extinction has the potential to escalate the behavior for a period of time before it decelerates. For this reason it is often combined with demand fading, which tends to buffer the burst of behavior that occurs when implementing extinction in isolation. Demand Fading In demand fading, the amount of engagement that is expected is gradually and systematically increased contingent on no (or low) levels of problem behavior substantially below baseline levels.

Examples of Antecedent‑Focused Intervention Strategies 59

In Reichle et al. (2010), the criterion for release was one unit of work during the first intervention session. Subsequently, contingent on two consecutive successful opportunities, the criterion was raised to two units of work. This progression continued contingent on meeting the same criterion at each new level. If the learner engaged in an error response (i.e., discontinued work, engaged in challenging behavior), the interventionist implemented the escape extinction procedure just described. Wacker et al. (2011) implemented a second version of demand fading that was embedded within an FCT program for escape-­maintained problem behavior. Demand fading was conducted as a two-step chain. Work completion produced a “play” card, and touching the play card resulted in an enriched break from work. The amount of work was very low (one or two task demands) initially and then doubled (e.g., two to four to eight), as the child successfully completed the task several times without problem behavior. The play card always signaled that a break was available if the child touched the card or pressed an attached microswitch. Earlier examples of demand fading have been reported by Fisher et al. (2000) and Hanley et al. (2001). In Reichle et al. (2010), both Mark and Pete increased activity engagement and completion with both general and explicit TFD strategies. However, each learner’s rate of successful work completion advanced more quickly when an explicit delay cue was implemented.

Procedural Variations Using the Logic of TFD There are a number of options available in implementing combinations of antecedent-­focused and communicative alternative interventions. Briefly, we provide examples of some of those options. Concurrent Implementation of TFD in Some Activities and a Communicative Alternative in Other Activities This strategy requires initiating the implementation of an antecedent-­ focused and communicative alternative intervention at the same time but in different activities. TFD is implemented in situations in which a communicative alternative could not be reinforced (e.g., taking medication). The communicative alternative intervention would be implemented in situations in which the social function associated with the learner’s behavior (e.g., saying “No thanks” to an offer to go to the grocery store with mom) can be reinforced. The advantage of a concurrent implementation of these strategies is that it gives the interventionist a strategy, should the learner overgeneralize the communicative alternative being taught. It also alters the response–­reinforcer relation that has been maintaining the problem

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behavior. The concurrent implementation of these two intervention strategies can be viewed as an application of a general case instructional strategy in which teaching opportunities for both negative teaching examples (when not to use a communicative alternative in this case) and positive teaching examples (when to use a communicative alternative) are addressed. The disadvantage of implementing these two types of interventions concurrently is that it requires the interventionist to implement two distinct sets of interventions concurrently that can be perceived as being more effortful. However, as reported by Stokes and Baer (1977), multiple examples often produce generalization across untrained examples. When desired generalization occurs, substantial savings in interventionist time also occurs. Sequential Implementation of TFD in Some Activities and a Communicative Alternative in Other Activities Although a somewhat less comprehensive implementation strategy, the sequential implementation of antecedent-­focused and communicative alternatives is probably a more frequently used implementation strategy. The disadvantage of sequential implementation is that there is an increased likelihood of continued emission of problem behavior in those situations in which the function that maintains the problem behavior is one that cannot be reinforced by producing a communicative alternative. As previously described in Chapter 3, Wacker et al. (2005) provided one example of sequential implementation. The participants were young children with disabilities who displayed problem behavior at home maintained by escape from task demands. FCT was implemented for all children by their parents (person), in their rooms (setting), and on a specific task such as picking up blocks (task). For each person, setting, or task variable, three additional persons, settings, and tasks were briefly probed but not included in the initial FCT. When the initial FCT was completed, the probes were repeated. If problem behavior occurred in any of these variables, FCT was reimplemented. In this way, generalization was assessed and FCT was implemented in a sequential fashion as needed (most often with tasks). In addition to TFD, there are other options available that can be implemented to moderate the use of communicative alternatives to problem behavior. We discuss some examples of these in the next section.

The Range of Social Functions That Are Relevant for a TFD Intervention Strategy Thus far, we have discussed the use of a TFD procedure with escape-­ maintained behavior. However, it can also be used to address the needs of persons who engage in problem behavior that is maintained by attention

Examples of Antecedent‑Focused Intervention Strategies 61

or access to goods and services. For example, consider a learner who approaches a teacher while he or she is working with another teacher. The teacher might implement a delay cue in the form of holding up an index finger to communicate (“Just a second”). Subsequently, the teacher finishes the ongoing interaction and turns her attention to the learner in need of attention by delivering a release cue in the form of motioning the learner to approach. In the case of problem behavior that is maintained by access to goods or services, consider the following example. As learner Tony finds a line in which to stand while waiting at McDonalds, a group home staff member says, “Almost our turn,” which serves as a delay cue. As the person in front of the learner finishes up, the clerk says, “What would you like?” which serves as the release cue to order food.

Delayed Reinforcement Accepting a delay in the delivery of reinforcement once work has been completed is an important example of a self-­regulatory skill that almost all of us accept. Although often implemented as a component of a TFD procedure, delayed reinforcement can be implemented alone (e.g., Fisher et al., 2000). For example, even though an individual puts in a full day of work, he or she typically would not expect to be paid for several weeks to a month later. Learning to postpone reinforcement can be very difficult for many learners and particularly those who engage in impulsive behavior. Our experience suggests some learners with development disabilities have difficulty with accepting a delay to the delivery of reinforcement perhaps, in part, because of the implementation of continuous schedules of reinforcement during skill acquisition. On the one hand, we know that immediate schedules of reinforcement are most effective in establishing new skills. We also know that high rates of reinforcement can strengthen the persistence of communicative behavior. On the other hand, the longer the history of enriched or immediate reinforcement, the greater the probability that unanticipated delays will produce a resurgence of problem behavior. In these instances, it may be necessary to implement a strategy to systematically increase the delay in delivering reinforcement. Most parents of children who engage in problem behavior that is associated with obtaining attention or tangible items/activities can relate stories of their child “melting down” because even though a reinforcer will be delivered, the learner must wait. Several years ago we worked with an adult with severe developmental disabilities who was reinforced with the delivery of an apple slice each time he correctly finished a math problem on a worksheet. This schedule of reinforcement, along with the teaching procedures being implemented, resulted

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in the acquisition of the skills that were required to solve the problems. When the teacher attempted to delay providing the apple at the end of the activity, the learner started refusing to participate. The interventionist then decided to gradually “move the reinforcer” to the end of the task. First, she established the delivery of two apple slices at the end of two problems, and then three at the end of three problems and so on. Eventually, this led to the delivery of the apple slices at the end of the task instead of during the task.

Unfortunately, for some learners delaying reinforcement is more challenging (this, in part, may be why moving to a token economy may be so difficult for some learners). In these situations, the TFD procedure that was previously described may represent a desirable alternative.

Prespecifying a Competing Schedule of Reinforcement to Moderate Overuse of a Communicative Alternative A competing schedule of reinforcement to moderate overuse of a communicative alternative involves offering the learner a choice between two viable response options. Each of those response options is associated with a different reinforcement value. In our previous example of overusing a break request, an alternative would be to associate a somewhat more extended engagement in the task with a higher-­quality or more potent reinforcer than the reinforcement outcome associated with a request for a break. Amira had quickly learned to request a break. Her teacher Anne noticed that Amira began using her break request with increasing frequency. Her teacher decided to reinforce break requests by allowing Amira to sit quietly and not engage in the task for 30 seconds contingent on a break request. On the other hand, if she continued to engage for a brief additional period, she would gain an unsolicited “enriched” break during which she could engage in a highly preferred activity for 3 minutes.

One caution is that when higher-­ value reinforcers are offered for harder work, learners who are impulsive tend to opt for the smaller reinforcer that requires less effort (Vollmer et al., 1999). In the Vollmer et al. (1999) study, impulsivity and self-­control involved a choice between a smaller more immediate reinforcer and a larger more delayed reinforcer. They reasoned that impulsive behavior would occur with more immediate smaller reinforcers at the expense of delayed larger reinforcers. They further reasoned that self-­control would occur when production of the target behavior produced delayed larger reinforcers at the expense of immediate smaller reinforcers. Two young boys with severe developmental disabilities participated. A functional analysis suggested that aggression was maintained by food and television access for one of the children. Interventionists

Examples of Antecedent‑Focused Intervention Strategies 63

implemented a differential reinforcement procedure in which appropriate requests were reinforced. Initially, aggression occurred when it produced immediate but small amounts of reinforcing objects/activities, even though mands produced larger, more delayed reinforcers. Both participants demonstrated self-­control when the delay to reinforcement was signaled (with a hand gesture or a timer). Thus, signaled delayed reinforcement may better enable differential or competing schedules of reinforcement to be implemented (see Falcomata et al., 2013, for further discussion of self-­control). Reichle and McComas (2004), which was originally discussed in Chapter 3, successfully implemented this strategy in teaching the moderated use of requesting assistance. They developed a two-­choice option for a learner who engaged in problem behavior to escape math worksheets consisting of problems that required carrying in order to solve addition problems. In this investigation, when the learner started using assistance requests with difficult math problems, he also increasingly began using assistance requests with problems that, during prior occasions, had been solved independently. The paragraphs that follow provide an example of how the procedure could work in teaching the learner to delay reinforcement when the interventionist wishes to more quickly extend engagement than might occur by relying exclusively on TFD. In this procedure, the objective is to make reinforcement magnitude or quality greater, contingent on longer engagement without problem behavior, when compared with the reinforcer available if a premature break request is reinforced. One challenge in prespecifying a competing schedule of reinforcement is familiarizing the learner with the choices that involve competing reinforcers. For example, 4-year-old Tobias and his mom often play the game Candyland. His mother told him that he can have one M&M after he takes his turn, or he can have five if he waits until mom takes her turn. To avoid the potential for learner negotiating, we believe it is often best if initially the differential is great enough to maximize the probability that the learner will accept a delay while engaging in the task at hand. In implementing this procedure, when the learner reliably picks the delayed reinforcement alternative, there are several variables that can be manipulated. Across successful opportunities the interventionist can either lessen the magnitude or quality of difference between reinforcers or can increase the delay time (or the amount of work to be completed) for the more desirable but delayed reinforcer to be delivered. During implementation, we encourage the interventionist to manipulate only one of these dimensions of reinforcement (see Mace & Roberts, 1993, for a discussion of dimensions of reinforcement and choice behavior) variables at a time. For example, the magnitude of reinforcement difference could be altered on one opportunity followed by a slightly increased delay time during the next opportunity. Across successful opportunities, each of

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these variables could be changed on a random schedule. To date there is very limited evidence validating this intervention, even though it seems to be a potentially promising application and is based on the research on variables influencing choice responding by Neef and colleagues (Neef, Mace, Shea, & Shade, 1992; Neef, Mace, & Shade, 1993).

Graphic Organizational Aids (Schedules) Some important routines occur every day at approximately the same time and are associated with predictable signals or cues. For example, the person who prepares an evening meal at approximately 6 P.M. calls, “Dinner is ready” to cue listeners that it is time to come to the table. Additional cues may include the aroma of cooking dinner, placing platters of food on the table, or movement of others toward the kitchen. Other routines, such as washing and drying clothes, occur less regularly and the associated cues might be somewhat less predictable. When natural cues are not sufficient to cue consistent participation, an individual may benefit from learning to follow a graphic schedule that signals when certain routines (e.g., washing dishes) are to occur. In our experience, for some learners, building a schedule over which they have some degree of control can be helpful. Most of us require reminders to facilitate participation in at least some aspects of our daily schedules (e.g., most of us use a calendar and to-do lists). Many persons use appointment books or electronic schedules on their smartphones/tablet computers to remind themselves of tasks scheduled for a particular day. Lists (e.g., shopping lists, to-do lists) are also a type of graphic organizational aid used by many individuals. Some persons with significant developmental disabilities may be unable to use some types of symbols used to communicate events that are represented in an organizational aid (e.g., printed words if one is not literate). Fortunately, there are a variety of graphic symbol types available. We begin our discussion of graphic organizational aids by describing variations of visual schedules that might be indicated for learners with developmental disabilities. Subsequently, we describe several schedule formats along with intervention procedures that we have found helpful.

Determining the Purpose of the Schedule to Be Taught within and across Activity Schedules Schedules can be thought of as being either focused within an activity or across activities. Within-­ activity schedules tend to be task-­ analyzed sequences that a learner must exercise to complete an activity. For example, in making a peanut butter sandwich, the learner must get peanut butter, a knife, and bread. Then he or she must open the jar, scoop and spread

Examples of Antecedent‑Focused Intervention Strategies 65

peanut butter, and fold the bread over to make a sandwich. An across-­ activity schedule, on the other hand, functions more like an adult’s daily planner with events of the day displayed so that an individual, after completing one activity, can refer to his or her schedule to select the next activity in which to engage. Time‑Based Schedules Another way to conceptualize a schedule is whether it is time based or activity based (McClannahan & Krantz, 1999). In a time-based schedule, the activity is time limited. For example, in a preschool, most activities last 10–15 minutes. In middle school, activities are often broken into 50-minute units. At the end of the time specified for the activity, the learner must move to the next activity on the schedule. In an activity-­based schedule, time is relegated to lesser importance. The issue in this type of schedule is following the activity sequence of the schedule, somewhat regardless of the time spent in the activity. For example, most of us have seen a learner who tantrums if he or she is not allowed to finish the task at hand prior to moving to the next activity on the schedule. Time-based schedules can present challenges to learners who lack flexibility (difficulty disengaging from one activity to move to another). Activity-­based schedules, on the other hand, can be very challenging to implement in classrooms or some group settings. For example, in a classroom, it can be important that each learner not be following a different schedule. In the remainder of this section, we explore implementation procedures for each of these schedule variations. Activity‑Based Schedules Some environments allow much more flexibility in individualizing the length of an activity. Giving a learner control over the duration of an activity may make it easier to focus on creating salient opportunities in teaching the learner to follow visual cues without being distracted by the amount of time he or she must engage in the activity. When the learner is independently following the schedule, a TFD can be implemented to increase engagement within an activity. Seven-year-old Robert often destroyed property. These destructive acts appeared to be maintained by escaping and avoiding nonpreferred activities. The only way that Robert’s mother reported that she could avoid property destruction was to allow him to watch movies all day. During a visit to Robert’s home, we learned that there were two primary functions associated with his challenging behavior: (1) escape from nonpreferred activities and (2) maintaining access to preferred activities. He produced problem behavior

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when he was required to engage in nonpreferred activities, such as brushing teeth, eating breakfast, working on the lawn, and going shopping with his mother. Additionally, Robert engaged in problem behavior that prevented the end of a preferred activity (e.g., watching videotapes, going to McDonalds, going to the movie store, going for walks that involved no task demands, baking cookies). During an assessment, educators discovered that Robert had excellent matching skills and could match virtually any line drawing or photo to its referent. In collaboration with his mother, we designed and implemented the following schedule for Robert. First, his teacher compiled a pool of graphic symbols representing highly preferred activities. Next, a similar pool of symbols representing less preferred activities was developed. Initially, Robert’s schedule consisted of three mildly preferred activities. He could have access to an activity for up to 10 minutes. After he terminated the activity, his teacher prompted Robert by motioning him to follow her back to his schedule, accept a gestural pointing prompt to select the next graphic on his schedule, and move to the next activity. Across successful opportunities, prompts were faded using a constant time delay prompting (systematically delaying the delivery of the prompts that exerted control over Robert’s actions). Eventually, Robert was able to move through a sequence of eight graphic symbols presenting activities that were mildly reinforcing.

A very important component of the instructional strategy that was just described involved identifying reinforcing activities. Procedures to identify reinforcers are described in detail in Chapter 3. Shifting from an Activity‑Based to a Time‑Based Schedule In our example with Robert, eventually it was important that he be taught to follow a time-based schedule to facilitate greater participation within a regular school routine. What follows is an example of the procedure that was implemented to systematically transition Robert from an activity-­based to a time-based schedule. Over a 2-month period, Robert’s interventionist implemented his schedule rigorously. Increasingly, the number of activities that comprised his schedule grew. Additionally, through the integration of the TFD strategy described earlier and a concurrent schedule of reinforcement, Robert’s length of participation in the activities was increased systematically. A concurrent schedule of reinforcers was established for Robert by arranging different choices. He used a digital watch and understood the use of a digital timer from his experience heating up pizza using a microwave oven. Upon arriving at an activity, his mother set the timer for a slightly longer period than he typically stayed. She showed Robert the timer and

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said, “Wait till the end, and we’ll have a little snack.” If Robert remained engaged until the timer sounded, he earned a pizza square on the way to the next activity. If he left the activity early, he received no pizza. The only time during the day that pizza was available to Robert was during successful transitions after he had participated for the time set on his timer. During the implementation of his schedule, Robert became better at increasing his level of engagement in activities. Initially, Robert’s interventionist focused on the sequence of events rather than the actual amount of time spent in a given task. When he was using his schedule, the interventionist increased the level of participation required during less preferred activities that were included in the schedule. When it was clear that setting the timer successfully led to increased engagement, his interventionist extended its use to assist in cueing Robert to disengage from highly preferred activities.

Below is an example of how procedures described earlier in this chapter can be combined when moving from an activity-­based to a time-based schedule. At the onset of a highly preferred activity, the interventionist set the timer for 10 minutes. When only 1 minute remained in the activity, a warning beep sounded. At that time, Robert’s mother said, “It’s almost pizza time.” As the beeper sounded to end the activity, the interventionist met Robert with a small wedge of pizza. If he disengaged and proceeded to the next activity, he received the pizza wedge. Next, the interventionist began delaying the delivery of the pizza wedge until, eventually, it was not delivered until Robert arrived at the site of the next activity independently and began engaging. In a final step, Robert had the choice between the small pizza wedge and a much more highly preferred item (e.g., baseball card). The card was available only if he completed the less preferred activity. Alternatively, he could have the pizza wedge immediately. Eventually, Robert was offered a package of baseball cards if he made it to a predestination mark on his schedule without accessing pizza or individual baseball cards (in Robert’s world, there was a clear hierarchy of reinforcers that went from a package of wrestling cards to baseball cards to pizza).

In Robert’s case, initially introducing the sequence of scheduled events depicted in a schedule was a higher priority than the length of engagement in each scheduled activity. Over time, the duration/quantity of participation increased as a result of the strategies that we have described. When the learner understands that once a sequence of activities is established, he or she must adhere to that sequence; the interventionist can offer an increased level of learner control to permit choices to be made within the schedule.

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Introducing Learner Choices in the Arrangement of Scheduled Activities Jointly Constructing the Schedule For some learners, schedules are less desirable because they do not provide sufficient control over aspects of a learner’s interaction with the environment. One option is to create a schedule that allows the learner some control over the design of the activities being arranged into the schedule. Several options are available when increased participation is the interventionist’s objective. One option is to work with the learner in jointly planning a schedule to be implemented. In this option, the interventionist can display two groups of graphic symbols representing events to be scheduled. One group can represent preferred activities (which the learner has control over), while the other can represent less preferred activities (which the interventionist controls). Across turns, the learner and the interventionist take turns placing events on the schedule. First, the interventionist explains or shows the learner how to select an activity from his or her (preferred) group and place it on his or her schedule. If the learner does not make a choice, the interventionist will make the selection. Next, the interventionist selects an activity from the less preferred group. It is important that the symbols chosen be placed sequentially on the schedule in the order that events are selected. Subsequently, the learner can select an activity from the more preferred group and so on until the schedule is completed. To enhance the learner’s interest in participating, it may be helpful to have a larger pool of activities available than those that will actually comprise the completed schedule. In the case of positively reinforcing activities, the learner will be afforded some choice in choosing the more preferred of available activities. Among less preferred activities, it will also provide the incentive of being able to avoid participating in the least preferred activity.

Initially, in constructing a schedule, it is somewhat probable that reinforcement will need to be increasingly more potent as the learner works through the schedule when given free choice in setting up the schedule. That is the learner is apt to place the more nonpreferred activities later in the schedule, while the more preferred activities may be apt to occur earlier in the schedule. This means that for less preferred activities occurring later in the schedule, expectations for length of engagement may need to be lessened. Consequently, as the schedule progresses, the interventionist may need to consider the use of additional reinforcement (to supplement the reinforcement value of preferred activities) during later-­occurring activities in a longer schedule of activities.

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One important rule involves not allowing the learner to change the schedule once it has been formulated. To allow frequent changes may confuse the learner’s grasp of why a schedule is being used. This is particularly the case if the learner is being concurrently taught to use a graphic mode communication system that allows the learner to freely choose symbols rather than follow a structured order. To make the difference between a schedule and a communication board/wallet clear, the learner should not be allowed to circumvent the schedule by rearranging events or picking and choosing which events to first complete once the sequence of the schedule has been established. The Wacker et al. (2011) study (described previously) provides a good example of escape extinction. In that study, the children needed to complete a small portion of a task before they could request an enriched break. Their parents were always very specific in their directing (e.g., “Place these two puzzle pieces here,” while pointing). When the direction was provided, the child had to complete the task independently prior to playing. All attempts to escape the task were ignored; the parents simply restated the direction or reminded the child that he or she could play when the task was finished. All children learned to comply. When a child’s behavior has no effect on the environment (in this case, does not allow for escape from the task), this is called extinction. As described by Lerman, Iwata, and Wallace (1999), extinction must be matched to the function of behavior, and so escape extinction was the type of extinction used in this example.

Presenting Interventionist‑Controlled Choices within a Schedule Another option of providing choices involves building them directly into the learner’s schedule once the learner understands that the activity order within a schedule must be followed. If choices are embedded too early in teaching a learner to use a schedule, the probability may be increased that the learner will confuse the purpose of a schedule with a communication board (in which the learner has somewhat free choice over the selection of symbols used). Figure 4.1 demonstrates how choices can be built directly into the learner’s schedule. When a single item is displayed on a row of the schedule it represents an obligatory activity in which the learner must engage in an activity. Alternatively, when a row of the schedule displays two activities a choice of activities is signaled to the learner. In this option, the learner can select either of the two depicted activities as the one in which he or she will engage. The preceding arrangement of activities addressed the possibility that a learner’s preferences may shift dramatically during the course of a day. One way to address this is to implement a schedule that incorporates numerous opportunities for choice.

Daily Schedule 8:30–9:00

Choices among Activities

Breakfast Expectations

Eat breakfast 9:00–9:50

9:50–10:00

Free choice (a good activity in which to conduct a reinforcer preference assessment)

OR

Choices available

   Trampoline      Puzzle

Cleanup time

Cleanup time 10:00–10:15 Free choice OR

   Toy clock      Snack 10:15–10:30 Crafts

Crafts 10:30–11:15 Free choice OR

      Color    Play an instrument

FIGURE 4.1. Example of a daily schedule that is organized to permit choices among preferred activities. 70

Examples of Antecedent‑Focused Intervention Strategies 71

Chunking Daily Schedules into Smaller Units When interventionists are just beginning to introduce a daily schedule, there may be a tendency to design and display the schedule for the entire day. For some learners, it may be advantageous to chunk their daily schedule into smaller units. With many learners, we suggest that their parent or educator plan the first two or three activities. Once those are executed, the next group of activities is added to the schedule. We make this suggestion for several reasons. First, during the early stages of intervention, it is easy to fall behind in the schedule. When this happens in school, there is a tendency for the interventionist to skip some items depicted on the schedule to “catch up.” Unfortunately, this sends the wrong message to the learner. By sequentially displaying portions of the daily routine, the educator can more easily compensate for scheduling dilemmas that arise. Another advantage of this strategy is that initially there are fewer symbols among which the learner has to discriminate. Third, if there are problems with the schedule (what is depicted, how it is depicted, etc.), these can be more quickly addressed if few activities are displayed.

Creating Additional Teaching Opportunities to Use a Schedule For some learners, implementing a schedule over the course of an entire day may not generate a sufficient number of instructional opportunities. When this is the case, there are options to supplement a daily schedule with additional opportunities to learn to use a graphic organizational aid. “To‑Do List” A to-do list, as depicted in Figure 4.2, displays chores that need to be completed during a relatively brief time span. We have found that in a home context, teaching a learner to use a to-do list may be easier than attempting to implement a schedule over a period of an entire evening. Experience suggests that introducing a to-do list that can be executed across a much shorter time may facilitate learning to subsequently use a daily schedule. For example, a learner may have a symbol labeled “Chores” on the daily schedule. After he or she seeks out a parent or educator, the adult can provide the learner with a pictorial to-do list. The to-do list then offers the learner an enhanced massing of practice opportunities. Community Shopping List Another strategy to increase instructional opportunities to teach schedule use also teaches a very functional skill and involves creating within-­activity

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Hang up coat.

Wash hands and face.

Take dog outside.

Wipe table.

Put dishes on the table for dinner.

FIGURE 4.2.  Example of a to-do list containing a list of household chores that a child needs to complete after school.

schedules. A community shopping list creates an opportunity to teach a learner to shop more independently for household items that frequently need to be replenished. The interventionist teaches the learner to select a graphic representation of an item. Next, the learner travels to the home storage location for that item. Here, the interventionist assists the learner in making a decision about whether to place the item on a shopping list. If it needs to be replenished, the symbol would be affixed to a shopping list. If it does not need to be replenished, the item would be returned to

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a storage container. At the store, the learner would be provided with an opportunity to match the graphic symbol representing the item to the actual product on the shelf. Subsequently, he or she would select and place the item in a shopping cart. Upon arriving home, the learner would be taught to match each product to its storage location as he or she stores the items purchased.

A General Sequence of Instruction in Setting Up an Organizational Aid Intervention Selecting an Easy‑to‑Identify Symbol First, it is important to choose the easiest representation for the learner. Graphic symbols can range from parts of objects (including wrappers) to printed words (see Johnston et al., 2012, for examples of assessment procedures to select symbols to use). On some occasions we have used to-do lists that utilize iPods that display video clips of actions being performed as the symbol representing a chore. It can be challenging to select the type of symbol that one wishes to use to represent events either on a communication display or in an organizational aid/schedule application. Often, in the past, we have implemented concurrent comparisons across symbol types (e.g., photographs, line drawings) using a simple discrimination task. In the task, we place two symbols in front of the learner. The learner is encouraged to select a symbol. In this task, it does not matter which symbol the learner selects. However, the one that is selected becomes the standard for the one that will be reinforced in subsequent selections. Across opportunities, we randomize the placement of the symbols. However, the one chosen originally is the one that continues to be reinforced contingent on the learner selecting it. If the learner is readily able to play this game, we conclude that this symbol type could potentially be used. If the learner continues to select randomly, it is unclear whether the learner can discriminate among different members of this symbol type. In conducting this assessment, if a learner readily demonstrated consistent selections for photographs but did not for black and white line drawings, we might consider using photographs (at least initially). If the learner did equally well across types of symbols, other factors may come into play in choosing the symbol type to use. If the learner did not do well across any of the symbol types, we may consider whether the symbols were too small. If we did not have information regarding visual acuity, we would refer the learner to an ophthalmologist (and would likely do so anyway if we were considering graphic symbols playing a key role in the learner’s communicative future).

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Establishing the Schedule as a Reinforcer One challenge in introducing a schedule is to get a learner interested in using the schedule. Consequently, even when the primary focus of a schedule is to remind a learner to engage in chores, we believe that the first program step is to establish the schedule as a conditioned reinforcer. Initially, the interventionist should identify a reinforcing item that can be depicted using its product logo or another graphic representation that will be recognizable to the learner. This will be the only item displayed on a graphic organizational aid (communication board or schedule). As soon as the learner arrives at the schedule and after being prompted to select the activity depicted, he or she is reinforced immediately. In implementing this step, an interventionist should use the least intrusive prompt that guarantees the learner’s approximation of the desired response. Across successful opportunities we then systematically fade the prompt (later paragraphs in this section address how to build the schedule). Selecting a Consistent Display Area for the To‑Do List Select a place for the list to which graphic symbols are used to prompt task engagement that is easy to locate, can remain the same over time, and is less apt to be accessed by others. Often, in a learner’s home, we use his or her bedroom closet door. We have also used refrigerator doors. At school, we have used lockers and cubbies with smaller children. Ultimately, the goal is to have a portable to-do list (i.e., a wearable wallet containing the schedule). However, with small children or with individuals who experience more severe developmental disabilities, teaching them to keep a to-do list with them may be an intervention objective in and of itself. Consequently, we often defer portability in favor of being able to focus on teaching the use of the schedule early in the implementation of this intervention strategy. Placing Symbols on the Schedule Sometimes, we affix self-­adhesive Velcro strips to the schedule. Initially, with a learner who has no prior experience using a graphic symbol system, we display a single symbol at a time. In introducing a to-do list to a learner who has not previously used a schedule we try, whenever possible, to utilize contingent access to preferred activities or the Premack principle (Premack, 1959). When a behavior that has a low probability of being produced is followed by a behavior that has a high probability of being produced, the likelihood of the low probability behavior being produced increases. By interspersing reinforcing activities with less reinforcing activities, the learner

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may be more likely to maintain engagement in the schedule. Others, such as Carr et al. (1994), referred to this strategy as embedding. Identifying a Natural and a Controlling Prompt That Will Result in the Learner’s Travel to the Graphic Organizational Aid Schedules will not work unless the user makes an effort to monitor the schedule. Even typical adults may miss scheduled meetings because they forget to monitor their schedule. To minimize this problem, the interventionist should select a natural cue that will remind the learner to monitor his or her to-do list. Often, we have used an inexpensive watch that allows an alarm to be set. For example, if a learner gets home between 3:30 and 4:00 P.M., an alarm on the watch could be set for 4:15 P.M. This alarm will be considered the natural prompt because it will never have to be faded. However, at first, the learner will not know what the beeper on his or her wrist going off means that he or she should do. Consequently, the interventionist must identify a controlling prompt (a prompt that is not regularly used by typical peers that eventually will need to be faded) that will be paired temporarily with the natural prompt (a prompt that will not have to be faded because it is one used on a regular basis by typical peers). As soon as the alarm sounds, the interventionist can implement the least intrusive prompt that is required that results in the learner traveling to the graphic organizational aid display. Across successful instructional opportunities, the controlling prompt (which has been paired with the natural prompt of a wrist alarm) can be faded systematically by implementing a prompt-­fading procedure. Often, we have used a constant time delay prompt (Holcombe, Wolery, & Snyder, 1994) after delivering the natural prompt and prior to the delivery of the controlling prompt. Constant time delays are easier for interventionists to implement with high fidelity compared with time delays in which the delay is systematically increased across successful opportunities. Alternatively, the interventionist may choose to gradually reduce the magnitude of the controlling prompt when it is delivered. For example, instead of using a partial physical prompt, the interventionist might fade to a gestural prompt. Reinforcing Correspondence between Symbol Selection and Travel to an Activity to Be Performed Initially, a symbol will be placed on the display. As soon as the learner examines the organizational aid, he or she should receive the least intrusive prompt that is required to remove the single symbol from the organizational aid. As soon as this occurs, the interventionist should prompt the

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learner to travel to the location where he or she can access the reinforcer depicted by the graphic symbol. As discussed earlier, for some learners, it may be important to have the reinforcer nearby so that it can be delivered immediately. During this phase of intervention, the learner need not discriminate among symbols. The interventionist simply wants to establish a history in which the learner is reinforced for traveling to the symbol display, removing a symbol, and subsequently traveling to the location where the item depicted by the symbol is kept. After the first activity has been completed, a second symbol will be displayed and the process repeated. Establishing a Discriminated Symbol Selection Eventually, the interventionist would like to be able to display a number of chores on the learner’s to-do list. This segment of the instructional strategy ensures that the learner can visually discriminate among graphic symbols that are displayed on his or her organizational aid. Initially, the interventionist can place a single symbol at a time on the display, as we described earlier. Sometimes the symbol will represent a known reinforcer. During other opportunities, the symbol might represent a chore that, in the past, has proven to be neither preferred nor particularly nonpreferred. Contingent on the learner successfully engaging in the less preferred chore when displayed, the interventionist will immediately deliver access to a preferred activity. During the early phases of intervention we have found that in selecting a nonreinforcing activity to place on the to-do list, it is important that the chore can be done quickly and is not among the least preferred. When the learner is using the to-do list, the interventionist should consider adding a greater range of less preferred work activities (being careful to appropriately provide equally powerful positively reinforcing activities as consequences for engagement). Introducing a Symbol Sequence One primary difference between a schedule (such as a to-do list) and a communication board is that, in a schedule, one must adhere to the predetermined sequence in which symbols are displayed. To a greater degree, the learner has a free choice of symbols that can be selected on a communication board. However, any form of a graphic schedule functions as an instructional prompt. Consequently, the items on the schedule should be treated as sequential and obligatory. In this step, the interventionist might sequentially place three symbols on the display consisting of a preferred activity, a less preferred chore, and a preferred activity. The first item on the to-do-list display will be

Examples of Antecedent‑Focused Intervention Strategies 77

a reinforcing activity. As the learner approaches his or her schedule, the interventionist should deliver the least intrusive prompt that will ensure that the learner selects the first symbol in the array. If the learner attempts to select a symbol out of sequence, it is important to interrupt the response (Ahearn, Clark, DeBar, & Florentino, 2007). Subsequently, the interventionist should bring the learner’s hand back to the starting point, impose a brief pause, and deliver the least intrusive prompt that is required to ensure that the learner selects the first symbol on the schedule. In the minischedule (or to-do list) depicted earlier in Figure 4.2, Carnell (who uses the to-do list depicted in Figure 4.2) must learn to first select a more preferred activity from his schedule (to increase the probability of returning to the list) after he has engaged in the reinforcing activity of taking the dog for a walk, followed by a less preferred activity. This alternating sequence would be replicated as the sequence of events on Carnell’s to-do list is gradually and systematically increased across successful opportunities. When the learner has selected a symbol, he or she should be provided with the least intrusive prompt that results in traveling to and engaging in the task. Initially, to avoid a struggle with less preferred activities, it may be helpful to choose tasks that can be performed in the room that houses the schedule. Doing so may help lessen the time on the less preferred activity so that the learner can quickly proceed to the more preferred activity. It is important that positive engagement and the absence of a major struggle be associated with the end of the task and a return to the schedule. This may mean that initially, for some activities, the interventionist may choose to assist or actually complete most of the steps of a task so that, when the learner arrives, the workload will be sufficiently modest that it will be easy to conclude “on a positive note.” Across successful opportunities, the expectations can be increased for the level of learner engagement. Contingent on successfully completing the first item on the schedule, the learner should receive the least intrusive prompt required to return to the to-do list, and the next activity on the list should be selected. A number of years ago, we met Cindy. She was an adult with a moderate developmental disability. Staff that worked with Cindy reported that she was quite “routinized.” Once she had sufficient experience with an activity that occurred on at least a daily basis, Cindy quickly gained independence in remembering to engage in the task. However, with tasks that occurred once or twice a week, she had a much more difficult time remembering to do them. In an effort to make Cindy less dependent on staff-­delivered verbal prompts, a to-do list or reminder list was introduced. Staff members who served Cindy in her group home made a list of activities that, typically, Cindy had a difficult time remembering to complete.

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Next, staff members identified a graphic representation for each activity. Interventionists reported that Cindy identified a number of product logos representing some of her favorite food items. They also reported that she was unable to match identical photographs or identical line drawings. Thus, real objects associated with activities or product logos served as symbols. Next, interventionists identified periodically occurring tasks that Cindy often failed to remember to complete (unless verbally prompted). Initially, staff identified two tasks that all agreed were important, but ones that Cindy never remembered to perform independently. One task involved making her lunch on Mondays, Wednesdays, and Fridays. A second task required Cindy to load the dishwasher on Tuesdays and Thursdays. Three days each week, Cindy was part of a motel cleaning crew. On these days, she brought her lunch to work with her. After a morning of work, she ate her lunch in the staff break room of the hotel. Dishwashing was a task that was shared between Cindy and her two roommates; she was assigned Tuesdays and Thursdays. Staff members reported that, although she readily engaged in each of these tasks, neither would be selected during a free choice of activities in which she could participate. Initially, it was important to demonstrate to Cindy the value of a to-do list. Interventionists identified several of Cindy’s highly preferred activities. They identified drinking Coke and watching movies as initial items to place on Cindy’s to-do list. After identifying work tasks and preferred activities, a symbol had to be chosen to represent each task. To represent packing a lunch, staff members chose a small brown paper bag similar to the type actually used by Cindy in packing her own lunch. Loading the dishwasher was represented with the product logo from the dish detergent that Cindy poured just before she closed the dishwasher door. To represent Coke, a color photocopy of the Coca-Cola logo was used. Finally, to represent movies, a color photocopy of a Blockbuster video logo was chosen. A staff member affixed self-­adhesive Velcro to the back of each chosen symbol. A strip of corresponding Velcro was affixed to Cindy’s to-do list so that symbols could be easily displayed. Next, interventionists identified a convenient location to place Cindy’s reminder list so that she could monitor it without it being bothered by other clients. They identified Cindy’s closet door in her room. Although reminder lists can be made portable, staff noted that Cindy did not like to carry a wallet. The final preparation for the introduction of the to-do list required identifying a natural prompt to remind Cindy to travel to her bedroom to check her list. Cindy enjoyed wearing jewelry. Consequently, an alarm could be set on an inexpensive wristwatch that Cindy enjoyed wearing. Because Cindy would be unaware of the purpose of the alarm the first time it sounded, a “controlling” response prompt was needed to ensure that as soon as the alarm sounded, Cindy immediately moved to her room and approached the

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to-do list. In the past, staff noted that if they approached Cindy and in an excited voice said, “I want to show you something,” Cindy readily followed. This served as the controlling prompt. The initial day of intervention, Cindy arrived home at around 3:30 P.M.; typically, she spent 20–30 minutes watching TV. After 30 minutes, she tended to lose interest and started somewhat aimlessly pacing the house. Consequently, her watch alarm was set for 4:00 P.M. To ensure that her initial experience with the to-do list was positively reinforcing, the single symbol chosen for display was the Coca-Cola logo. At 4:00 P.M., the alarm on Cindy’s watch sounded. Obviously surprised, she raised her hand in the air and shook it. Immediately, staff approached and said, “Cindy, come on, I have something to show you.” Cindy quickly followed the staff member into her bedroom. When they arrived at the to-do list, the staff member took Cindy’s hand and physically prompted her to remove the Coca-Cola logo and give it to the staff member. Staff immediately responded, “Right, it’s time for a Coke.” Cindy ran to the refrigerator with staff quickly in pursuit to deliver the beverage. During the next several opportunities to use the to-do list, Coke and movies were alternated as the represented activity. Interventionists began to fade the delivery of the prompts that they had been using. First, interventionists delayed the delivery of the controlling verbal prompt used to get Cindy to travel to her bedroom. As soon as the alarm sounded, staff waited for 5 seconds before delivering the verbal prompt (controlling prompt). On the third opportunity, Cindy moved to her room upon hearing the alarm in the absence of any staff-­delivered verbal prompt. Interventionists implemented a second prompt-­fading strategy to reduce the need for a staff member to be present. As Cindy moved to her room, physically prompting her hand to the symbol was faded quickly. After four opportunities, Cindy was selecting and offering the symbol to staff with no physical response prompting. Finally, staff faded their presence. Instead of standing at the to-do list with Cindy, staff began to stop at the entry of the room so that Cindy had to remove the symbol and walk to staff at the door and then offer the symbol. She was successful at this during the initial fading opportunity. Subsequently, interventionists waited an increasingly greater distance from the doorway. Eventually, Cindy had to travel back to the living room with her retrieved symbol in order to offer it to staff. It was clear that she valued the to-do list, as was evidenced by her efforts to occasionally check it even when the alarm had not sounded. Next, interventionists introduced symbols that actually represented work. Initially, interventionists introduced the symbol for making lunch. The small brown paper bag was affixed to the to-do list. As Cindy approached the to-do list, she was obviously disappointed. However, she did pull the bag from the list. Then, the staff member immediately approached and said, “All right, we’re going to make lunch.” Subsequently, the staff member walked

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with Cindy to the kitchen, where she proceeded to engage in making her lunch. At the conclusion of the task, the staff member said, “Let’s go see your board.” Cindy ran back to the to-do list, where there was a Coca-Cola logo. She returned to the kitchen with the logo. The interventionist delivered a Coke immediately. During the next several opportunities, the interventionist repeated the preceding sequence, alternating between the two chores and the two reinforcing activities for which symbols had been created. Subsequently, the interventionist displayed two symbols simultaneously. A symbol representing a work chore was placed first and a positively reinforcing activity was placed second on the display. The first time that Cindy encountered the display of two symbols, she attempted to select the positively reinforcing symbol. As she reached for it, the staff member immediately delivered a response prompt to direct her hand to the first symbol on the display. Cindy then reached for the symbol corresponding to the chore. In our experience, when two symbols are first displayed on a to-do list, the learner often appears to assume that he or she has a choice among tasks. If, at this point in the program, the learner is allowed to make choices, the distinction between a schedule and a communication board used to produce requests may be very confusing. Once Cindy was performing well with a display of two symbols, the interventionist introduced a third. In this sequence, a positively reinforcing activity was placed first. This symbol was followed by a symbol depicting a less reinforcing chore. Finally, a third symbol representing a highly preferred activity was placed in the array. The goal of this step of the procedure was to ensure that Cindy was able to use the to-do list to direct her engagement in a chain of activities. As Cindy’s array of tasks increased, interventionists carefully continued an alternation from a more to a less preferred activity. With Cindy’s to-do list, interventionists sought to begin to incorporate some choice and control for her. In this step, whenever Cindy encountered a preferred activity in her to-do list, there were two options, as depicted earlier in Figure 4.2. Whenever interventionists placed two symbol choices horizontally in the symbol display, she could choose one of the two symbols. On the other hand, the presentation of a single symbol signaled that engagement in the task was obligatory. In Cindy’s case, the use of a to-do list was useful in promoting less dependence on staff’s verbal prompts to engage in tasks. The to-do list provided her with an improved ability to self-­regulate her behavior. Being able to make choices among preferred activities gave Cindy a greater level of control over some aspects of her daily routine than she had an opportunity to exercise in the past. As the chain of symbols increased, Cindy’s to-do list began looking more and more like a daily schedule. For many learners, we have found the use of the to-do list to be an efficient method of entry to introducing a more longitudinal daily schedule.

Examples of Antecedent‑Focused Intervention Strategies 81

A Brief Summary of Prompting Strategies Throughout much of this chapter, we have discussed prompting and prompt-­fading strategies. Consequently, a brief overview may be in order. We have discussed response prompting, which involves assisting the learner in producing a behavior. The other type of prompting is referred to as stimulus prompting. In stimulus prompting, the goal is to establish prompt-­free learner responses under very simple conditions, and then alter the difficulty of the stimuli presented that requires a response. For example, consider teaching a learner to select a symbol displayed on a communication board. Initially, the interventionist might display a single symbol for the learner to select. Once the learner is locating the symbol, the interventionist might add a second white symbol that has no depiction on it. If the learner continues to select the original symbol, the interventionist might begin to add depiction to the second symbol (from which the learner is to refrain from selecting). If successful, the learner will select the original depiction over the second symbol that now has a complete depiction, and the interventionist might add a third symbol. Next, on some occasions, a correct learner response would occur by selecting symbol A and during other occasions selecting symbol B. In this example, the second symbol was added by gradually building it into the array (stimulus shaping). A second technique is stimulus fading. For example, assume that a teacher wanted to teach the learner to sight-word read cup. Originally, the teacher might teach the learner to say “cup” in the presence of a line drawing of a cup that had the word cup superimposed on the cup. Across successive successful teaching opportunities, the line drawing of the cup is gradually removed so that the learner’s attention is shifted to the printed word. This is referred to as stimulus fading. Response-­prompting systems are those in which the assistance is delivered by the interventionist after, or concurrently with, the presentation of the target SD. Verbal prompts, model prompts, and physical prompts are the most common general categories of prompts that can be delivered by the instructor. These prompts may involve interventionist actions that range from full physical guidance to partial physical guidance to touching the learner. „„Gestural. These prompts typically involve motioning toward a referent, pointing, and so on, and the interventionist does not come into direct physical contact with the learner. „„Model. Models involve demonstrating a target behavior for a learner. „„Physical.

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Picture prompts involve visual depictions of where to go or what to do. The schedules (either within task or across tasks) described earlier are examples. „„Verbal. A spoken prompt that tells the learner to perform the desired response. „„Picture.

Once one has found an effective prompt to use with a learner, it is often important to fade (or gradually remove) the prompt. This can be accomplished in a number of ways. Some strategies involve conducting the fading while staying within a type of prompt, while other strategies involve transitioning across types of prompting strategies. For example, for a within-­prompt-­type fade that involves a physical prompt, the interventionist might transition from a full physical prompt to a partial physical prompt to touching the learner and then eliminating the prompt. In an across-­prompt-­t ype fading strategy, the interventionist might transition from a touching physical prompt to a gestural prompt to no prompt at all. Examples of the prompts just described are illustrated in Table 4.2. One prompt-­fading strategy is a time delay prompt-­fading strategy. Let us assume that an interventionist wishes to fade the use of a spoken prompt. One strategy is to simply delay the delivery of the prompt by several seconds. By doing so, one hopes that the antecedent events that occur immediately prior to an opportunity to respond will begin to exert instructional control over the learner’s response. If after several seconds the learner has not yet responded, the original prompt that results in a successful learner response is delivered. Over time, as the learner is successful, the delay for delivering the original response is gradually increased, with the goal being for the learner to respond to the naturally available cues that are available to guide responding. An example of each prompting strategy is provided in Table 4.2. With individuals who engage in significant levels of problem behavior, it may be desirable to initially deliver the least intrusive prompt level that consistently results in a correct response approximation and then fade it. This may help to minimize the probability that the learner engages in problem behavior before a prompt can be delivered. For this reason, make sure that the delay interval is very brief at the beginning of fading, and then lengthen the interval once the learner is successfully following the prompt and not engaging in problem behavior. If problem behavior occurs prior to the delivery of a response prompt, the interventionist may need to add some latency between the problem behavior and the delivery of the prompt. In an earlier chapter, we described a learner who mastered producing the two-step chain in which he pinched and then requested a desired item. A similar two-step chain can occur in this situation in which problem behavior is followed by the response prompt, which then immediately results in

Examples of Antecedent‑Focused Intervention Strategies 83 TABLE 4.2.  Summary of Response Prompt Fading Techniques Procedure

Example Fading while staying within prompt type

Altering the magnitude of a prompt: The force of the prompt is lessened across successful opportunities.

Moving from taking a learner’s hand and placing it on a symbol to touching the top of the learner’s hand.

Altering the locus of prompt control: The point of contact with the learner’s body is altered as the prompt is faded.

Moving a prompt from the wrist to the forearm to the elbow (this movement results in a lessening of the prompter’s control over moving a learner’s hand to contact a symbol).

Altering a prompt’s release point: The delivery of a prompt is released at an earlier point during the emission of a response.

Moving from maintaining contact with a learner’s wrist throughout the delivery of a response prompt, and releasing the learner’s wrist at earlier and earlier points during the response emission.

Time delay: The delivery of a prompt that was used at the outset of response prompt delivery is delayed.

Constant time delay involved always waiting for the same length of time. Waiting 4 seconds, for example, prior to delivering a prompt that originally was delivered immediately.

Fading across different forms of prompts Physical prompt: Physical contact is provided to guide the learner through the entirety of an action.

After asking a learner to pick up a cup, a parent takes the child’s hands, molds them around the cup, and then lifts the child’s hands.

Gestural prompt: An action produced by an individual to direct the behavior of another that includes but is not limited to pointing, nodding, or any other type of action.

Prompting the learner to pick up a cup by pointing to a cup.

Verbal prompt: The learner is provided with a spoken prompt to guide the learner’s response.

To prompt a child to pick up a cup, a parent might say, “Pick up the cup.” A specific verbal prompt, as above, can be given, or a more general prompt, such as “Please pick it up.”

Graphic or textual prompt: The learner is provided with a picture, line drawing, or printed or other graphic form to direct the learner’s response.

Providing a picture of a cup to draw the learner’s attention to it.

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the delivery of reinforcement. Delaying the prompt following the display of problem behavior also delays the presentation of reinforcement, and so problem behavior serves to only delay reinforcement.

Setting‑Event Interventions Thus far, we have provided examples of antecedent-­focused strategies that have included changes in MOs (TFD, competing schedules of reinforcement) and changes in discriminating stimuli (schedules/organizational aids) that involve prompt fading as interventions that can be implemented to teach the learner to better regulate his or her behavior. Other antecedent interventions can be implemented that may fall under the category of setting-­event interventions (Bambara & Kern, 2005), which can complement any of the examples of interventions that we have been discussing. A setting event is a physiological, social, or environmental condition, past or present, that enhances the salience of an antecedent event that is associated with problem behavior (Bambara & Kern, 2005). There are a number of different types of setting events that are depicted in Table 4.3. An example of the importance of setting events and their potential influence on problem behavior can be seen in the example below and as depicted in Table 4.4. Often when we visit with teachers and parents, they explain that a learner’s problem behavior occurs very inconsistently on an apparently random basis. Of course, this could be the case. On the other hand, the perceived randomness could actually be a reflection of changes in the environment, and specifically whether setting events are or are not operating. Table 4.4 demonstrates the influence of the presence compared TABLE 4.3.  Different Types of Setting Events Type

Examples

Physiological

•• Pain or discomfort from illness or medication •• Fatigue

Cognitive/emotional

•• Argument with friends/family •• New social situation

Physical environment

•• Loud noises •• Lack of light or too much light

Social activity

•• Presented with a novel task •• Change in routine

Note. Reprinted from Bambara and Kern (2005) with permission from The Guilford Press.

Examples of Antecedent‑Focused Intervention Strategies 85 TABLE 4.4.  Example of the Importance of Setting Events and Their Potential Influence on Problem Behavior Setting event

Maintaining consequence

Antecedent

Behavior

Absent

The teacher tells the class to work on their math assignment.

Daniel raises his hand to obtain assistance from his teacher.

The teacher offers Daniel her assistance.

Present

The teacher tells the class to work on their math assignment.

Daniel throws his book ot the floor. He places his head on his desk.

The teacher offers Daniel her assistance.

with the absence of a setting event. Note that the maintaining consequence is the same but that in the presence of the setting events, problem behavior occurs and is reinforced. We distinguish setting events from MOs based on their relationship with the terminal or maintaining reinforcer. MOs have a direct relationship to an identified reinforcer, and their presence momentarily alters the value of the reinforcer.

Differentiating between Setting Events and MOs A setting event sets up a chain of events that leads to different classes of behaviors than occur if the setting event does not occur (e.g., emotional behavior after being frustrated or irritated). An MO results in a temporary change in motivation or the perceived value of a reinforcer, and an increase in all responses that historically have resulted in that reinforcer. The most common example is deprivation/satiation. Wacker, Harding, et al. (1996) provided one example of how MOs quickly alter the reinforcing value of positive reinforcers. A learner engaged in severe self-­injury that initially appeared to be random and not socially differentiated. Sometimes he engaged in self-­injury that appeared to occur when he was hungry, but at other times he engaged in the self-­injury immediately after eating. The interventionists finally discovered that there were two reasons or two MOs that influenced his displays of self-­ injury. When he was hungry, he engaged in self-­injury until he could eat. When he was not hungry (e.g., after meals), his self-­injury was maintained by attention. Separate analyses of his behavior were needed pre- and postmeals to identify that there were two MOs for his behavior. Because there were two MOs underlying his behavior, the FCT program needed to involve two outcomes of manding: one to eat and one for attention. This was initially confusing for his mother and the interventionists because he engaged in the same

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topography of behavior but for different reasons or functions. Identifying the MOs helped the interventionists to develop a highly effective intervention.

Setting events often lead to the initial responses of a chain of behavior, such as emotional behavior, that does not appear to be clearly related to functional reinforcers. It is likely that the chain of behavior was historically reinforced, but the current response–­reinforcer relations are unknown. For example, we worked with a typically developing junior high student who was in a school program for children with behavior problems. His behavior was very confusing to his teacher because some days he would be pleasant and cooperative, and other days he would swear and react angrily even when first greeted by his teacher. His initial response to a greeting by his teacher first thing in the morning seemed to result in a chain of behavior. If he responded positively, he was pleasant to everyone and compliant to requests made by his teacher. If he reacted angrily, he often got into fights with other students and was noncompliant. His teacher discovered that he was also often hungry when he was irritable, and so made fruit available to him every morning. Starting his day by eating fruit seemed to alter his behavior, such that it increased his compliance and overall affect. His teacher was never able to determine what the exact response–­reinforcer relationship was for his problem behavior, but was able to identify the correlation between eating and improved behavior at school.

Unlike the previous MO example, in which food was the maintaining consequence for problem behavior when that child was hungry, in this case, it appeared to be related to problem behavior in a correlated but unknown way that led to different chains of behavior. In Figure 4.3, Bambara and Kern (2005) provided a decision tree in the design of a setting-­event intervention. The initial question to be answered after the setting event has been identified is whether it can be eliminated. If the answer is “Yes,” the problem is solved. Kennedy and Itkonen (1993) showed that one woman’s problem behavior was associated with oversleeping in the morning. The intervention was to teach her how to set an alarm. If the answer is “No,” the interventionist has two questions to address. First, can one ameliorate the influence of the setting event (e.g., air-­ conditioning activated in a room that is too warm)? Alternatively, can one modify the immediate antecedent event that precedes the learner’s opportunity to respond? For example, by prespecifying a very powerful reinforcer, the learner may be more likely to tolerate the setting event. Alternatively, one may be able to lessen the magnitude of the setting event. For instance, in the example above, if food changes the student’s affect, then a different chain of behavior may be emitted. If loud noises disturb a learner, it may be possible to have the learner wear earplugs or listen to music during the

Examples of Antecedent‑Focused Intervention Strategies 87 Setting event identified

Can setting event be eliminated? No

Yes

Eliminate

Remove/modify immediate antecedent

Ameliorate influence of setting event

FIGURE 4.3. Intervention approaches for setting events. Reprinted from Bambara and Kern (2005) with permission from The Guilford Press.

activity to lessen the setting event’s intensity. In another example, if the event cannot be ameliorated, the question becomes, “Can the interventionist modify the immediate SD associated with the challenging behavior?” (e.g., if a learner escapes difficult math problems, start his or her worksheet with very easy problems and embed more difficult problems within the worksheet). What follows is an example of a learner with whom we worked with a number of years ago. Ralph’s teacher asked us to observe him during the first 90 minutes of the school day. He had a history of severe but inconsistent problem behavior that ranged from no aggression to 20 instances of aggression during the first 90 minutes of the school day. His aggression often caused injury to others. One morning, Ralph’s bus driver made the comment that if he got into one more fight on the morning bus ride, that he would no longer be able to ride the bus. His teacher asked what happened. The bus driver explained that some mornings when Ralph got on the bus he seemed to be in a bad mood, and often, as soon as one of several other boys made a comment with which Ralph disagreed, he “lost it” and started to hit the peer. His teacher immediately talked to Ralph’s parents to attempt to determine what might be upsetting him before he arrived at school. Ralph’s parents identified three variables at home that included sleeping less than 5 hours a night, rushing to get ready in the morning, and being heavily prompted to get ready for school, and (of course) the fight on the bus. Subsequently, his teacher continued to monitor instances of Ralph’s problem behavior during the first 90 minutes of the school day. Additionally,

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she set up a setting-­event checklist (see Figure 4.4) to monitor events that might be serving as setting events for Ralph’s aggression. Below are the data that we obtained from the implemented assessments. The frequency of aggressive behavior was monitored during the first 90 minutes of the school day. Additionally, the setting-­event checklist, described in the preceding paragraph, was applied to determine which of the possible setting events that had been identified from the parent interview may have occurred on any given school day. Ralph’s parents checked whether he slept less than 5 hours and also whether he had to be heavily prompted (which was operationally defined in the assessment protocol) to get ready for school. The bus driver told a paraprofessional who met the bus whether or not aggressive physical contact occurred during the ride to school. A careful examination of the data displayed in Figure 4.4 demonstrated that the greatest combination of hypothesized setting events that occurred on

1. Didn’t sleep more than 5 hours 2. Fight on bus

9/1

9/2

9/3

9/4

9/5

9/8

9/9

9/10

+

+

+

+

+

+

+

+

+

3. Frequently verbally prompted getting ready for school

+

+

+

+

16 Instances of Aggression

14 12 10 8 6 4 2 0

9/1

9/2

9/3

9/4

9/5

9/6

9/7

9/8

9/9

9/10

Days

FIGURE 4.4. A setting-­event checklist and a graph depicting the frequency of aggression during the initial 90 minutes of Ralph’s school day.

Examples of Antecedent‑Focused Intervention Strategies 89

a given day correlated with an increase in the number of aggressions on that same day during the first 90 minutes of school. Although a correlative and not a causal demonstration, these data suggest that implementing setting-­ event interventions might represent at least part of a comprehensive behavior support plan.

In Ralph’s case, two setting-­event interventions were implemented. First, we ameliorated the influence of one setting event by using assigned seating on his bus. Ralph was assigned a seat at the rear of the bus since he boarded first, and the children with whom he frequently fought had assigned seats at the front of the bus. The other intervention involved a combination of removing some of the events that caused Ralph to become somewhat upset in the morning and reinforcing on-time behavior. During our assessment, we noted that Ralph had a number of morning chores before school that he liked to do but often contributed to his parents’ need to heavily prompt him to prepare for school. Our intervention to address this was twofold. First, we reduced the number of Ralph’s morning chores by encouraging him to make some choices. For example, instead of picking his clothes out in the morning, he chose to do it the night before. Instead of feeding the dog in the morning, he chose to feed the dog in the evening and let his mom do it in the morning. Instead of helping cook all of breakfast, he picked one thing to help with (e.g., make toast, microwave oatmeal). As a result of these interventions, his problem behavior during the initial 90 minutes of the school day decreased substantially.

Building Rapport as an Example of a Setting‑Event Support Strategy Carr et al. (1994) described the importance of building rapport with learners who may have a propensity to engage in problem behavior. Although rapport does not sound like a behaviorally operationalized term, Carr and colleagues (1994) referred to rapport building as an essential component of a behavior support plan (see also Hanley, Jin, Vanselow, & Hanrahy, 2014). In order for the learner to use a communicative alternative effectively and in a generalized fashion, he or she must approach individuals prior to communicating. Some adults in the life of an individual with problem behavior may have relied extensively on reactive intervention procedures (e.g., verbal reprimands). With these persons, the learner may actively avoid social contact. In this situation, building rapport is a strategy to reverse this avoidance behavior. We consider this to be more of a setting event than an MO, because the relationship between the antecedent event and the functional reinforcer is unclear. The person clearly does not want to be in the environment, and so exhibits escape-­maintained problem behavior when given

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demands. However, even when not given demands, the person appears to be unhappy, and when permitted to escape, the person continues to exhibit inappropriate and unhappy behavior, and the functional reinforcer remains unclear. Perhaps the most straightforward way to build rapport (establish the interventionist as a conditioned reinforcer) is to initially make no or few demands on the learner and instead provide preferred items or activities. By doing so, the interventionist begins to create a history of reinforcement being associated with an interventionist. Concurrently, the interventionist should seek to pair his or her presence with items and/or activities that the learner finds reinforcing. Contingent on the learner approaching the interventionist, the learner is reinforced. With some learners who are very reluctant to initially approach an interventionist, the interventionist may offer a reinforcer, place it on a table, and then move away. Across consecutive successful opportunities, the interventionist remains closer and closer to the reinforcer. If we are successful and the interventionist becomes a conditioned reinforcer, then the entire context (e.g., the classroom or group home) may also become conditioned as reinforcers and we increase the learner’s overall motivation to respond for positive reinforcers. Many years ago we worked with a preschool child who had autism. His mother was worried because he resisted all contact with her. As part of a comprehensive FCT plan, we told his mother to carry a container of cookies (his favorite food) and to offer them whenever he approached her. Initially, this meant just standing near her. Across days, we required more contact from him prior to receiving his cookies including hugs, tickles, and highfives. He appeared to like tickles, and so we quickly replaced cookies with tickles.

When a learner consistently approaches the interventionist, it should be possible to begin to thin (or fade) the reinforcer by delaying its delivery on a variable schedule. Doing this may begin to facilitate teaching the learner to accept delayed rather than immediate reinforcement. Finally, reinforcement is placed on an intermittent schedule—­that is, the learner is not always reinforced with the original reinforcers that were used as part of the instructional procedure. In considering this intervention strategy, it is possible that the learner has simply been taught to approach an adult because it results in reinforcement. If so, “true rapport” may not have been developed, even though to the observer it appears to be rapport. The other possibility is that by initially conditioning the adult as a source of reinforcement, the learner began to increasingly sample social reinforcement that, over time, has taken on

Examples of Antecedent‑Focused Intervention Strategies 91

a reinforcing quality of its own. Either way, however, the learning history increases the probability of the learner making appropriate requests and interacting with the interventionist in an appropriate way.

Summary This chapter has discussed a sampling of antecedent-­focused strategies that we have found helpful in a variety of situations. Antecedent-­focused interventions are useful when the functional reinforcer that maintains problem behavior cannot be provided immediately for appropriate communication. In this respect, antecedent-­focused interventions can represent an intervention that is complementary to teaching a communicative alternative by enhancing a learner’s skill in self-­regulating his or her behavior. An example of this application that we described was using a communicative alternative to avoid a particular food item, but utilizing an antecedent-­focused intervention strategy in a situation where a communicative alternative could not be reinforced. A second application of antecedent-­focused interventions can be to assist the learner in moderating his or her use of a communicative alternative that has been taught. For example, requesting a break with increasing frequency can occur once the learner associates it with brief release from aversive situations. By adding a TFD procedure to a successful procedure that has been used to teach break requests, an individual can learn to lengthen engagement between the necessities of using a break request. Finally, some antecedent-­focused interventions directly address setting events or MOs. For example, if a SD for challenging behavior is enhanced in a room that is too warm, the simple antecedent-­focused intervention of making the room cooler represents an antecedent-­focused intervention. MOs change the reinforcing value of a consequence and need to be considered when conducting an intervention, because the same problem behavior can function at different times to obtain very different reinforcers.

Chapter 5

Teaching Communicative Protesting as an Alternative to Avoidance‑Maintained Problem Behavior with Quannah Parker-­McGowan and Jeff Sigafoos

T

here are a variety of socially acceptable communicative acts that one might teach as an alternative to existing problem behaviors that occur to escape and avoid (i.e., are maintained by negative reinforcement). These potential communicative acts include protesting (current chapter), requesting assistance (Chapter 6), and requesting a break (Chapter 7). This chapter considers communicative protesting, which some refer to as rejecting (Reichle et al., 1991). In this chapter, protesting and rejecting can be considered to be comparable terms that refer to the same social communicative function. Communicative protesting can be defined as the use of appropriate communicative forms produced to avoid or escape from nonpreferred objects, activities, or interactions with other individuals (Sigafoos, O’Reilly, Drasgow, & Reichle, 2002). Protesting can be distinguished from requesting a break because the former involves attempting to avoid or escape the nonpreferred object, activity, or interaction without having to participate at all (avoid). Alternatively, if the activity becomes aversive once an individual engages in it, by producing a protest, he or she need not complete or return Quannah Parker-­McGowan, PhD, is a Postdoctoral Fellow in the Leadership and Education Program at the University of Minnesota. Jeff Sigafoos, PhD, is Professor of Educational Psychology at the University of Wellington, Victoria, New Zealand.

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Protesting as an Alternative to Avoidance‑Maintained Problem Behavior 93

to the activity or interaction (escape). Requesting a break, in contrast, enables a person to gain a brief respite from tasks with the expectation that he or she will return. Requesting assistance is also different from protesting in that teaching the person to request assistance (help) is intended to replace problem behavior that occurs when the person is unsuccessful in completing a task independently, such as requesting help to access a book that is located on an out-of-reach shelf or assistance with a difficult task. Consequently, it is important to remember that protests are not the only suitable option for addressing behavior that is maintained by escape. Table 5.1 provides examples of communicative functions often implemented to address escape-­functioned problem behavior.

What Is Communicative Protesting? The production of a communicative protest is maintained by the delivery of negative reinforcement. With negative reinforcement, a learner’s behavior (e.g., the learner saying, “Stop that!”) is reinforced by the removal, withdrawal, postponement, or cessation of a nonpreferred object, event, or

TABLE 5.1.  Examples of Communicative Functions Often Implemented to Address Problem Behavior Maintained by Escape Function

When to use

When not to use

Protest/reject

John has been asked to go shopping, which he hates to do. Instead of tantrumming, he says, “No thanks.”

John has been asked to take seizure control medication because he must take the medicine. Saying “No thanks” cannot be reinforced (an antecedent-focused intervention will likely be necessary in this situation).

Request break

Sam has been steadily working to complete a worksheet. Upon completion and before he begins his next assignment, he requests a break.

Sam has been asked to take seizure control medication. A break request cannot be reinforced prior to taking the medication.

Request assistance

Mark requests assistance with a new assignment after he has tried to complete the problems unsuccessfully with no assistance.

Mark refrains from requesting assistance with a given problem once he has been shown how to complete it.

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person (thus, negative reinforcement is also involved in requesting a break, and can be involved in requesting assistance). For example, in the case of protesting, an adolescent may say, “Turn it off,” when a nonpreferred song is played on the radio. Alternatively, a child may view a parent about to serve up a large portion of broccoli and avoids this by communicating a protest: “No thanks.” Teaching socially acceptable forms of communicative protesting to individuals who engage in problem behavior makes sense from both a developmental and a functional perspective. Developmentally, protesting is among the earliest communicative functions to emerge in typically developing individuals (Carpenter, Mastergeorge, & Coggins, 1983; Crais, Douglas, & Campbell, 2004). From a functional perspective, protesting can provide an effective and socially appropriate means to avoid contact with nonpreferred objects, activities, and persons. Opportunities to produce a protest are likely to arise across a wide range of environments and during a number of daily interactions. This, in turn, should facilitate a number of opportunities for persons in the learner’s environment to maintain the behavior once it is established. Additionally, unless socially appropriate protesting is taught in a manner that promotes generalization (see Chapter 3), a learner might persist in his or her use of early emerging protesting that often consists of problem behavior or more idiosyncratic forms that are socially limiting (e.g., turning one’s head away when offered an item). Depending on how efficient these problem behaviors are in producing reinforcement, they may persist even when the appropriate behavior has been acquired (Lieving et al., 2004; Richman, Wacker, Asmus, Casey, & Andelman, 1999). These authors showed that when learners acquire appropriate communication responses, those responses are added to an existing response class. When we indicate that an appropriate communication response has replaced problem behavior, what is likely happening is that the appropriate communication response is now more likely to occur, or to occur prior to the display of problem behavior. Unfortunately, problem behavior is retained in the response class; it just occurs less often or under different conditions. This is important, because if appropriate communication fails to produce reinforcement (i.e., is on extinction), or is less efficient or much more effortful to produce than problem behavior, then problem behavior will reappear or show resurgence (Lieving & Lattal, 2003). As we mentioned in Chapter 1, resurgence will likely continue to occur quickly if appropriate communication is not reinforced, even after FCT has been implemented for several weeks or months (Wacker et al., 2011). This does not mean that we cannot continue to adjust the treatment (e.g., require that more work be completed or that different choices be made by the learner), but we must remember that if we make too many adjustments too quickly, we may see the reoccurrence of problem behavior (Volkert et al., 2009).

Protesting as an Alternative to Avoidance‑Maintained Problem Behavior 95

If problem behavior does reoccur, this does not mean that treatment has failed. There is likely no need to completely discontinue the treatment or to completely start over. Too often we see interventions changed completely when problem behavior reoccurs. Resurgence of problem behavior is common in all applied and clinical contexts. As shown by Volkert et al. (2009), it can be a function of fidelity (i.e., the treatment is no longer being implemented as intended), or it might be a case of making too many adjustments too quickly. Treatments that are based on differential reinforcement procedures, such as FCT, can take a very long time before we can say they have resulted in maintenance (i.e., that the effects of treatment will persist despite challenges such as brief periods of extinction; Nevin & Wacker, 2013). We have been conducting FCT programs via telehealth (e.g., using Skype at The University of Iowa and Google Hangouts at the University of Minnesota) directly in parents’ homes for several years (Suess, Wacker, Schwartz, Lustig, & Detrick, 2016). One of the most common fidelity problems we encounter is the failure of parents to immediately reinforce the appropriate communication response produced by their child (Suess et al., 2014). For example, in the case of delivering a break from a task that has become aversive, instead of providing reinforcement, a parent, understandably, may want the child to complete more work prior to being able to take a break or to choose a different task. This is a common and often a successful approach; as the child learns to complete a task, more is expected from him or her. However, if problem behavior reoccurs, the simplest approach may be to reduce the demand to a previously successful level or increase the choices offered to the learner. Once improvement has occurred again, the adjustment can be attempted again. Over time as appropriate behaviors are strengthened with reinforcement,and problem behavior is weakened with extinction, the effects of treatment will likely persist, even when those adjustments are repeated. Idiosyncratic, less conventional behaviors can lead to problem behavior because they are difficult to interpret, which, in turn, can result in a learner escalating to producing problem behavior that is more transparent for a listener. This is what is meant by a response class hierarchy. The learner’s initial response does not produce reinforcement and so chooses another response, in this case, a problem response to obtain reinforcement. Further, some contexts may be more tolerant of problem behavior. For example, when interacting with a familiar person, pushing away an unwanted item may communicate that an individual does not want the item and the familiar adult removes the item. However, when produced while interacting with a less familiar person, it may mistakenly communicate that the learner wants no further social interaction and the person leaves. Because producing a less conventional behavior to protest (Iacono, Carter, & Hook, 1998) increases the probability of a communicative breakdown (which in turn

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FUNCTIONAL COMMUNICATION TRAINING FOR PROBLEM BEHAVIOR

may lead to the production or resurgence of problem behavior), transparent conventional communicative behaviors need to be trained as replacements for problem behavior that is maintained by social outcomes. From the very beginning of the intervention process, protesting represents a potentially important communicative behavior that enables learners to empower themselves to gain release from an unwanted object, event, or person’s attention.

The Development of Early Protesting We know quite a bit about the emergence of protesting in typically developing individuals. Wetherby and Prizant (1993b) reported that prior to producing intelligible words, protests comprise approximately 5% of children’s early prelinguistic productions and approximately 11% of children’s multiple word communicative productions. Rudiments of protesting have been observed at very early ages. As early as 7 months of age, infants have been reported to use a variety of behaviors to protest the delivery of certain items and events. Crais et al. (2004) reported back arching as an early volitional form of protesting. We have observed that as early as 5 months of age, children engage in a variety of subtle protesting-­like behaviors when undesired food was delivered. For example, when a spoonful of a less preferred food was offered, children waited longer to open their mouth, and once the food was in their mouth, waited longer to swallow it. Children also dribbled more of the less preferred food from their mouth, and after a spoonful of nonpreferred food was expelled, the child did not reestablish eye contact very quickly with the parent who was delivering the food. Early protesting is not limited to the use of natural gestures. During the first few months of life, children cry as much as 2 hours a day. Much early crying comes under the control of environmental stimuli that are associated with certain states and related events. For example, infants as young as 16 weeks of age will fuss when they lose contact with the nipple (Gesell & Ilg, 1937). At 3–4 months of age, children have been observed to be significantly more likely to fuss near mealtime. Events such as those just described represent key opportunities for adults to teach children that their behavioral acts can be used to control the actions of others in the environment.

Implications for Intervention from Natural Parent–Child Interactions Behaviorally speaking, it would appear that providing positive or negative reinforcement after crying would strengthen it. However, Bell and

Protesting as an Alternative to Avoidance‑Maintained Problem Behavior 97

Ainsworth (1972) reported that children whose parents contingently acted on their child’s crying behavior during the first 6 months of life cried significantly less during the second half of the first year when compared with children whose parents were less attentive to crying. One might have expected that if crying was reinforced, its frequency would continue to increase. The fact that this did not seem to happen in this study might be explained in terms of response shaping and differential reinforcement. In the following scenario, we assume that a parent would find a child’s crying aversive. Consequently, after repeated episodes of crying, the parent might begin to anticipate when his or her child may be likely to start crying and takes steps to preempt the crying at its earliest point. This would result in the parent becoming increasingly attentive to the child’s crying and to the situations/contexts that tend to precede crying. Given this enhanced degree of attentiveness, the parent may be apt to respond more immediately when his or her child begins fussing in an effort to get the crying to stop quickly. The reason that parents do these things can be explained in the same functional way that children engage in certain behaviors when confronted with aversive events—­negative reinforcement. In negative reinforcement, an individual engages in a behavior to terminate or avoid an aversive event. Consequently, if a parent can catch a child very early in the sequence of behavior that leads to crying (and acts to reinforce the circumstances that match the function of the child’s behavior), the aversive stimulus (i.e., the child’s crying) is apt to terminate more quickly. By reinforcing less vehement fusses, the parent may be beginning to shape vocal behavior rather than crying. Our experience suggests that sometimes infants become so worked up (emotional) that, even when the event associated with their crying is resolved (they are positively or negatively reinforced), they continue to cry. This might be referred to as a “carryover” effect. This carryover of crying may occur, in part, because infants have a limited ability to self-­regulate their emotions and behavior. Consequently, once a crying episode “gets going,” it may take a while for the child to calm down and for the crying to stop. This notion may be applicable to some individuals with significant developmental disabilities who have difficulty self-­regulating their behavior. In an early article addressing crying, Wolff (1969) observed that “the infant discovers a new way of crying which many mothers identify as ‘faking,’ implying by this that the infant has no distress but simply ‘wants attention’ ” (p. 98). “Fake crying” was also reported more recently by Nakayama (2010). Our experience suggests that during an episode of fake crying, the child begins to engage in what appears to be the onset of a crying episode. During this episode, the child periodically pauses, as if to check for an adult response. If, after repeated checks, the adult is not forthcoming with the

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desired outcome, crying follows. However, if at any point the adult delivers the outcome associated with crying, the child is able to abruptly terminate the cry. Whereas real crying has both an emotional and instrumental component, fake crying seems to have a purely instrumental function, and operates as a learned communicative response. Another characteristic of typically developing children is the wide variety of different forms of behavior that they have to convey the same communicative function. They may be likely to engage in a host of somewhat more socially acceptable behavior that tends to immediately precede crying. If so, a parent who is motivated to avoid crying might deliver the desired consequence immediately after these more socially acceptable behaviors (and prior to crying). Consequently, it may be likely that the adult may deliver reinforcement before the learner has had a chance to engage in a “full-blown” crying episode. It seems likely that children who have the greatest number of different socially acceptable behaviors that occur prior to crying (which also provide an effective cue for the adult to respond in ways that will preempt crying) may be those whose behavior would be easiest to shape into alternative responses to crying for communicating a protest. We are proposing that a very similar operation be used with children who have developmental disabilities and engage in problem behaviors. Sometimes, adults have a propensity to be less responsive to desirable behaviors than to problem behaviors. One reason for this lack of responsiveness is that problem behavior consumes so much of the adult’s time that whenever the child is doing well, the adult attends to other demands on his or her time. Parents commonly tell us that they feel guilty because they spend so much of their time dealing with one child’s problem behavior. They feel that this may shortchange their other children’s needs. Teachers often make similar comments. When a child is behaving appropriately (who has a history of frequent problem behavior episodes), the parent or teacher may consider this to be a good opportunity to attend to their other children or students. Although this can lead to short-term benefits (e.g., less guilt), as discussed in Chapter 3, it will almost certainly lead to ongoing, long-term problems with the behavior of the target child because appropriate behavior will never replace problem behavior in the response hierarchy. In summary, the combinatory effect of limited responsivity to social overtures produced by children with significant developmental disabilities and their limited behavioral repertoire make it important to focus on intervention strategies that can be used to teach the child to use a variety of socially acceptable responses to communicate a protest. The more appropriate protest responses the learner has, the more likely it is that these responses will replace problem behavior for significant periods of time within specific contexts.

Protesting as an Alternative to Avoidance‑Maintained Problem Behavior 99

What Do We Know about Teaching Protesting? Reichle, Rogers, and Barrett (1984) taught protesting to a 15-year-old girl with developmental disabilities who was nonverbal. When offered nonpreferred items, she learned to produce a sign approximation to indicate “no.” Initially, the interventionist identified nonpreferred items via a free operant preference assessment (see Chapter 3 for a description of preference assessment). When offered, the learner avoided taking each of these items. Subsequently, during intervention, a tray containing nonpreferred items was offered. At the same time, the interventionist asked, “Want one?” The learner’s production of the sign “no” resulted in the removal of the nonpreferred items. If the learner did not sign “no,” the interventionist more directly offered one of the nonpreferred items. When the learner resisted the offered item (e.g., turning away from item), physical assistance was used to prompt the production of the “no” sign. Across successive teaching opportunities, prompting was faded systematically using a fading of response prompt position, as described in Table 4.2 in Chapter 4. This procedure resulted in the acquisition of a protesting communicative act that was controlled by the presentation of nonpreferred items. Drasgow, Halle, and Ostrosky (1998) used similar prompting procedures to teach a 4-year-old child with a developmental disability to protest (reject) the offer of nonpreferred objects (e.g., foods, beverages). Along with strategies to teach socially acceptable protesting (or rejecting) responses, it is often necessary to establish conditional use of communicative protesting. Conditional use (see Chapter 3) means that the learner can discriminate when to use a protesting communicative act and when to either refrain from using a protesting response or engage in a different communicative act. Hung (1980) described an intervention strategy to teach the conditional use of requesting and protesting to two children with autism. Participants were taught to say “Yes” when offered preferred food items, and to say “No” when they were offered nonpreferred food items. The interventionist offered an item and asked, “Do you want [name of food item]?” Contingent on the child saying “Yes,” the item was provided. Correspondingly, when the child said “No,” the item was removed. Intervention procedures included the use of modeling, error correction, and dif‑ ferential reinforcement. Both children learned to produce “Yes” or “No,” conditionally. In teaching conditional use of “yes” and “no,” Duker and Jutten (1997) described procedures for teaching this skill to three adults with severe/profound intellectual disabilities. Participants were taught to use manual signs to indicate either “yes” or “no.” First, preferred and nonpreferred objects/ activities were identified for each participant. For two of the participants, a “yes” gesture was taught prior to a protest gesture “no.” For the remaining

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participant, a protest gesture was taught first. When the “no” gesture had been acquired, the learner was taught to produce the “yes” gesture. All three participants rapidly increased correct responding when the first gesture was being taught and decreased correct responding when intervention to teach the second gesture was initiated. Eventually, correct discriminated use of both communicative acts was acquired. The procedures implemented by Hung (1980) and Duker and Jutten (1997) were effective in teaching conditional use of “yes” and “no” vocabulary as requests and protests, respectively. An interventionist’s challenge is to create a situation in which the desired communicative act can be prompted prior to the production of a more socially inappropriate means of protesting, such as moving away, pushing the item away, or starting to cry. If well-­established but unconventional (e.g., pulling, tugging) communication or problem behavior is produced prior to or during the delivery of an instructional prompt, the interventionist runs the risk of establishing a chain of behavior that includes the more inappropriate behavior followed by the behavior that the interventionist is trying to teach. If this occurs, the interventionist may be successful in teaching a new socially acceptable communicative act. However, at the same time, the less socially acceptable act may not necessarily decrease in frequency. As Mace et al. (2010) observed, if behaviors are in the same response class and one behavior is reinforced, then so are other behaviors in the same response class, even inappropriate behaviors. What follows is an example of the implementation of a strategy to teach protesting. Howard had a history of slapping undesired food from his plate onto the floor when it was offered to him at mealtime. Because Howard was doing well nutritionally, his interventionist decided that he would allow Howard to avoid any food item, contingent on the production of a socially acceptable communicative act. On day 1, the interventionist approached Howard with a vegetable that he always refused. Carefully, the interventionist observed the point at which Howard established eye contact with the offered item and then shifted his eye gaze to the individual delivering the item. As soon as these events occurred, the interventionist removed the food item, thereby preempting problem behavior. During subsequent opportunities, the interventionist approached with undesired food items by moving closer and closer to Howard following each successive successful intervention opportunity. This action increased the amount of time between Howard’s attention to the object and the removal of the item. Eventually, the interventionist began to touch Howard’s arm just before the nonpreferred food item was removed. Finally, as Howard’s propensity to produce problem behavior significantly diminished, the interventionist delivered a physical prompt to produce a gesture indicating “no” and

Protesting as an Alternative to Avoidance‑Maintained Problem Behavior 101

then removed the item. Each of the steps prior to this last one was designed to increase the probability that a response prompt could be delivered in the absence of problem behaviors, and thus separated the previously acquired problem behaviors from the newly acquired communicative act. Across the next group of intervention opportunities, the interventionist focused on systematically fading the level of prompt required to obtain an approximation of the gestural (protest) response, similar to the fading procedures used by Reichle and Johnston (1999), among others.

A Guide to Teaching Protesting1 In teaching socially acceptable protesting, a variety of slightly different intervention strategies can be implemented. What follows is a summary of a procedure that involves using a strategy to first deliver negative reinforcement in the absence of the problem behavior. Again, we recommend this approach because it separates the communicative act from the problem behavior and reduces the probability that they will be formed into a two-step chain. Across successful opportunities, the response is prompted. Finally, response prompts are faded (see Chapter 4). This approach can be thought of as a stimulus control approach that, in this example, results in an attempt to minimize errors or the emission of problem behavior. Stimulus control occurs when behavior is produced in the presence of specific signals/cues in the environment, but is not produced when those signals/ cues are absent.

Identify the Critical Event That Cues the Child to Engage in Escape‑ or Avoidance‑Motivated Problem Behavior It is important to identify the critical event that is associated with the onset of escape or avoidance. 1 The

description of the procedures that follow were adapted from “Communicative Replacement Strategies for Challenging Behaviors That Serve the Function of Avoid/ Escape: Rejecting,” Principal Investigators Joe Reichle, PhD, and Mary McEvoy, PhD, and Co-­I nvestigator Carol Davis, EdD, University of Minnesota. This project was supported in part by Grant Nos. HO24D40006 and H024P10017 from the U.S. Department of Education to Joe Reichle, PhD, and Mary McEvoy, PhD, at the University of Minnesota. Contributors include Mary Ann Marchel, Laura Moore, Shelley Nielsen, April O’Keefe, Melissa Olive, Amy Richardson, Rebecca Smith, Kathleen Wolff, Robert Utke, Kathryn Drager, Susan Johnston, Kathleen Feeley, Michael Harris, Elisabeth Rogers, Virginia Traylor, Sandy Charron, Amy Hicks Marquez, Gretchen Jackson, Karen Anderson, Judy Bartlett, and Kayleen Vieberg.

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Each day when Paul noticed his teacher gather the gym equipment, he began to tantrum. Paul’s teacher used the recording system (see Figure 5.1) to determine the point at which Paul threw himself on the floor. Across 10 days, Paul participated in a group game activity until his teacher removed the gym equipment from the storage cabinet. At this point, Paul threw himself on the floor.

Identify Specific Activities That Can Serve as Teaching Examples During situations in which a functional analysis (see Figure 5.2 for a description and example of a brief functional analysis conducted in an outpatient clinic) demonstrated that a behavior was maintained by escaping or avoiding an item, event, or person that was possible to escape or avoid, the interventionist should consider teaching a protest. Identify specific activi‑ ties that are associated with problem behavior to avoid/escape. (In the case example in Figure 5.2, Gary’s mother did not care whether he completed puzzles, and so he could avoid this task if he made the appropriate protest request.) Make sure that these teaching examples sample a full range of conditions associated with the problem behavior that are similar to those in which you hope to obtain a newly acquired protest. Also, identify activities from which the learner cannot be permitted to escape (for Gary, this would Student name:  Paul  Observer: T. K. Activity:  Group activity in gym

  Nonpreferred item:  Gym equipment

Entering gym

Group game

Gym equipment brought out

10/12

10/11

10/10

10/9

10/8

10/5

10/4

10/3

Problem Behavior(s)

10/2

Step in Activity

10/1

Session

Totals

Throwing self

0/10

Yelling

0/10

Crying

0/10

Throwing self

0/10

Yelling

0/10

Crying

0/10

Throwing self

+

+

Yelling

+

Crying

+

+

+

+

+

+

+

+

+

10/10

+

+

+

+

+

+

+

+

9/10

+

+

+

+

+

+

+

8/10

FIGURE 5.1.  Protesting observation form for Paul.

Percentage of Intervals with Inappropriate Behavior

Protesting as an Alternative to Avoidance‑Maintained Problem Behavior 103 Gary’s Problem Behavior

100 90 80 70 60 50 40

demand

diverted attention

30 20

free play

10 0

1

2

3

4

5

6

7

8

9

10

11

12

Sessions

FIGURE 5.2.  Brief functional analysis for Gary. Gary was 3 years old, diagnosed with autism, and engaged in problem behavior such as aggression and self-­injury. The brief functional analysis was conducted during one 90-minute session in an outpatient clinic. His mother conducted the sessions with assistance from behavior analysts working in the clinic. The brief functional analysis, so termed because it was conducted in one 1- to 2-hour period of time, evaluated problem behaviors when Gary was playing with his mother (free-play condition; conducted on sessions 1, 2, 4, 6, 8, 10, and 12), when his mother’s attention was diverted away from him but provided for 20–30 seconds each time he displayed problem behavior (attention condition; conducted on sessions 9 and 11), and when he was given a demand (to complete a puzzle at a table) that he could escape for 20–30 seconds each time he displayed problem behavior (escape sessions; conducted on sessions 3, 5, and 7). All sessions were conducted for a maximum of 5 minutes each, with the entire brief functional analysis being completed within 60 minutes. As shown in the figure, problem behavior occurred most often and most consistently in the demand condition, identifying a negative reinforcement (escape) function. This surprised his mother, who thought Gary engaged in problem behavior when he was overly excited or frustrated.

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mean demands that he cannot avoid, such as brushing his teeth). Together, these activities comprise negative teaching examples because the learner would not be allowed to escape from the activity (e.g., toothbrushing) even if he or she produced a socially acceptable protest. Still, the interventionist could react to such protests in a neutral manner, such as by saying, “I know you don’t like this, but it has to be done. When we finish, you can watch your favorite cartoon” (see Chapter 7). Instruction should begin with both positive and negative teaching examples. Initially, these examples should be maximally discriminable. example: When approached with the gym equipment, Paul will emit his protesting response. „„Negative example: While engaged in an activity in the classroom where no gym equipment is present, Paul will refrain from engaging in the protesting response. „„Positive

Identifying negative teaching examples is a particularly important responsibility for the interventionist. If the interventionist reinforces the use of a protesting communicative act in situations where eventually the protesting act cannot be reinforced, there is an increased chance that an extinction burst will occur. An extinction burst occurs when an individual is no longer reinforced for a previously reinforced behavior. For most of us, a common example is an extinction burst that occurs at vending machines. Obtaining a beverage is the reinforcement for placing money in the machine. Upon unknowingly encountering a broken vending machine (i.e., after inserting coins and selecting a beverage, nothing happens), receiving no beverage constitutes extinction (eliminating reinforcement for a previously reinforced behavior). If we have no alternative way to obtain a drink, our responses are apt to become more frequent (e.g., frequently touching the button corresponding to the beverage that was selected originally) and may appear to be more random (e.g., touching any button in hopes of obtaining some beverage). These new responses are ones that characteristically have been paired with reinforcement for this MO within this context (Michael, 1982); thus, if the individual continues to be motivated to drink, he or she will continue to engage in behaviors that historically have been paired with reinforcement. After receiving no beverage, he or she may begin to display other behaviors in the hierarchy, such as pounding on or kicking the machine (aggression) before walking away from the machine. At this point, as was true for the individual who was crying in our earlier example, we would say that he or she has “lost control” and the behavior is as much emotional as functional. If a history of reinforcing the use of “no” occurs in situations that cannot eventually be sustained, the interventionist runs the risk of establishing the

Protesting as an Alternative to Avoidance‑Maintained Problem Behavior 105

conditions for an extinction burst when he or she attempts to tighten the range of situations in which the use of a socially acceptable protest will be negatively reinforced. Consequently, we suggest clearly identifying posi‑ tive and negative teaching opportunities from the outset of intervention to increase the probability that the learner will be able to discriminate when to emit the appropriate communication response. Once we have made the examples different enough that the learner discriminates between them, we can then slowly remove the added prompts. Across opportunities, teaching examples should be made less discriminable, making it less obvious to the child whether the communicative response is to be produced. Extinction (see Iwata, Pace, Cowdery, & Miltenberger, 1994, for a description of extinction) is an important tool in establishing communicative alternatives to problem behavior. Applying it consistently to problem behavior can assist in weakening the problem behavior while, concurrently, the new communicative alternative is being strengthened via reinforcement, and it will make it clearer to the learner what needs to be produced to obtain the desired outcome.

Identify a Socially Acceptable Communicative Means Some learners may already have a socially acceptable way to indicate a desire to avoid or escape a nonpreferred item or activity. The interventionist may wish to consider using one of these means as a communicative alternative for problem behavior. During some observations, Paul raised his arms in a push-away gesture when attempting to protest, after which he began to engage in problem behavior.

In attempting to establish generalized use of an existing communicative means already produced by the learner, the interventionist must carefully consider using a socially acceptable behavior that occurs as the initial step of a chain that leads to problem behavior. Paul has also been observed to say “No” to protest his parent’s request for him to participate in some activities. However, this verbalization always rapidly leads to shouting; continued repetition of “No, no, no, no, no”; and crying.

In this situation, it may be more desirable to select a new communicative act to teach. Otherwise, the interventionist will be unable to reinforce Paul for the use of the socially appropriate “no” without reinforcing him for the rest of the chain: the loudness, the repetition, and the crying. Winborn et al. (2002) examined the influence of teaching appropriate novel mands and appropriate mands that were already part of a learner’s repertoire to

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FUNCTIONAL COMMUNICATION TRAINING FOR PROBLEM BEHAVIOR

replace problem behavior. When reinforcement for either mand was concurrently available, children chose existing mands more often than novel mands. It is likely they chose the existing mand because both the existing mand and problem behavior had become members of the same response class; both had been reinforced over time within the same context. Unfortunately, this also meant that problem behavior was likely to have co-­ occurred with existing mands, and this is exactly what Winborn et al. (2002) found in their study. When both the novel and existing mands were available, the participants chose to use the existing mand, and when using the existing mand, also often displayed problem behavior. This is because both the existing communicative act and the problem behaviors were members of the same response class (Mace et al., 2010). When two responses are in the same response class, reinforcing one inadvertently reinforces the other. This means that interventionists need to be particularly observant of chains of behavior that involve socially acceptable and unacceptable behaviors that are used for the same communicative function. Sometimes a learner may already have a socially acceptable communicative act that he or she uses in a very different communicative context. When offered a preferred beverage, Jack usually accepts. After two to three offers of refills, he politely shakes his head “no.” On the other hand, whenever he is presented with a task demand to pick up his toys, he almost always tantrums and has not been observed to use a head shake.

In the preceding example, Jack seems to have learned to associate the use of a socially acceptable communicative protesting act with situations that involved the satiation of positive reinforcement. However, he does not appear to associate the use of a “no” head shake with situations that involve negative reinforcement. There are a number of explanations for Jack’s pattern of protesting use. Perhaps problem behavior has been more consistently reinforced than head shaking in situations that involved task demands. It is also possible that he simply did not generalize the mand across the functional contexts of positive and negative reinforcement. Falcomata et al. (2013) taught children with severe intellectual disabilities to request attention with one sign, to request tangibles with a second sign, and to request breaks from demands with a third sign. The children learned to independently produce the signs in all contexts. The authors also noted generalization errors, meaning the “wrong” sign was emitted. The majority of the errors occurred across the attention and tangible contexts, the two positive reinforcement contexts. Very few errors occurred from positive to negative reinforcement contexts or from negative to positive reinforcement contexts. For interventionists, this lack of generalization should be anticipated and trained explicitly if desired (e.g., to emit “please” across all three contexts).

Protesting as an Alternative to Avoidance‑Maintained Problem Behavior 107

Determine the Form and Consider the Efficiency of the Communicative Replacement It is essential for the interventionist to consider the relative efficiency of the communicative response and the learner’s existing escape behavior to ensure that the communicative alternative is efficient from the learner’s perspective. As discussed in Chapter 1, response effort, rate of reinforcement, immediacy of reinforcement, and quality of reinforcement represent important parameters of efficiency to consider. Table 5.2 illustrates how

TABLE 5.2.  Examples of Parameters of Response Efficiency Problem behavior

Inefficient response

When Paul is in the presence of gym equipment, he throws himself to the floor, yells, and cries.

An inefficient communicative replacement for Paul might be to first get his teacher’s attention, and then use his push-away gesture.

Efficient response

Response effort An efficient communicative replacement from Paul’s perspective would be to produce the push-away gesture immediately upon encountering the gym equipment.

Rate of reinforcement Following Paul’s tantrum to escape, his teacher and the classroom assistant allow him to leave the gym.

It would be inefficient from Paul’s perspective if he had to use his push-away gesture repeatedly before he is allowed to escape the gym activity.

When Paul emits his communicative alternative (i.e., push-away gesture) the first time, his teacher and classroom assistant let him leave the gym.

Quality of reinforcement After Paul tantrums to escape, his teacher allows him to leave, and allows access to computer games (a preferred activity).

It would be inefficient from Paul’s perspective if, after he emits the push-away gesture, his teacher merely allows him to leave the immediate area, but requires him to stay close by.

Following Paul’s protest, his teacher and classroom assistant are sure to allow him to leave the gym and go to a preferred activity.

Immediacy of reinforcement When Paul tantrums, his teacher immediately allows him to leave.

Following Paul’s protest, his teacher did not release Paul until she finished what she was doing.

When Paul produces a communicative alternative, his teacher or classroom assistant immediately approached him upon seeing him use his pushaway gesture.

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FUNCTIONAL COMMUNICATION TRAINING FOR PROBLEM BEHAVIOR

an interventionist might consider each aspect of response efficiency when teaching a socially acceptable protesting communicative act.

Identify a Provoking Event In delivering a potentially provoking event, the interventionist should carefully observe the exact point at which the learner engages in problem behavior or engages in a chain of behaviors that leads to problem behavior. Paul’s teacher used the recording form in Figure 5.3 to note that when she is within 5 feet of Paul holding gym equipment, he disengages from the ongoing activity. When she gets to within about 2 feet, he is likely to engage in problem behavior.

This intervention will be implemented at a point that reliably occurs prior to a learner’s attempt to avoid.

Student name:  Paul  Observer: T. K. Activity:  Group activity

  Nonpreferred item:  Gym equipment Time Engaged OR Distance of Item/ Activity Presented

Date

Antecedent

(circle one)

Problem Behavior

10/15

Gym equipment brought out

2 feet

Throwing self, yelling, crying

10/16

Gym equipment brought out

5 feet

Disengaged from group activity

10/17

Gym equipment brought out

4 feet

Disengaged from group activity

10/18

Gym equipment brought out

3 feet

Disengaged from group activity

10/19

Gym equipment brought out

2 feet

Throwing self, yelling, crying

FIGURE 5.3.  Protesting observation form for Paul: Critical distance.

Protesting as an Alternative to Avoidance‑Maintained Problem Behavior 109

Sequences of Intervention There are two different sequences of intervention that can be implemented in teaching communicative protesting. Decelerating less socially acceptable behavior prior to teaching protesting is implemented when it is impossible to successfully prompt a protesting response in the absence of socially unacceptable behavior. However, if a socially acceptable protesting response can be prompted without the likelihood of the child producing unacceptable behavior, the interventionist may consider skipping directly to directly teaching protesting.

Decelerating Problem Behavior Prior to Teaching Protesting Some socially marginal behaviors may occur as soon as it becomes apparent to the learner that a task demand is about to be made. For example, a learner may run away when the teacher offers task materials or when the parent approaches with the child’s toothbrush in hand. As we discussed previously, problem behaviors may be higher in the response hierarchy, and so are emitted first. In these cases, it may be impossible to prompt a socially acceptable protest prior to the emission of less desirable behavior. Alternatively, with some children, it may be impossible to deliver a response prompt without the child engaging in problem behavior. If one encounters one of these situations, it may be desirable to decelerate a problem behavior before attempting to prompt a communicative alternative. Reinforce the Absence of Problem Behavior The interventionist should approach the learner, and the provoking item or activity should be removed prior to the production of problem behavior with the acknowledgment that the child did not wish to engage. The objective of this step is to reinforce the absence of problem behavior in the presence of some level of the provoking item/activity. Paul’s teacher approaches him with an undesired activity and says, “Oh, Paul, you don’t want to play with the gym equipment today. That’s fine. You can sit on the side and look at your books.” In this case, Paul was reinforced with avoidance without having to engage in problem behavior. In most communication intervention programs, a specific response like a communicative response has to occur prior to reinforcement. In situations in which problem behavior occurs too quickly and perhaps with too much intensity to prompt an appropriate response, we suggest using a differential reinforcement of other behavior (DRO)approach in which the only requirement for reinforcement is the absence of problem behavior, initially for very

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brief periods of time. Over time, increase the interval of time that has to occur without problem behavior prior to providing reinforcement.

Systematically Alter the Presentation of the Provoking Item/Activity So That It More Closely Resembles the Original Provoking Condition While still maintaining an absence of problem behavior, begin to increase the magnitude or proximity of the critical item/activity until it closely approximates the conditions that were present prior to the implementation of intervention. If proximity of the gym equipment functions as the provoking context for Paul, move it systematically closer across successive instructional opportunities before removing it and allowing him to escape the activity.

Directly Teaching Protesting Prompt the Protesting Response When the provoking event has occurred, but before the problem behavior has been produced, prompt the child to produce a protest. The specific prompting strategy that the interventionist selects will depend on the communicative means to be used (i.e., graphic, gestural, or vocal) and the prompt type required to obtain correct response approximations. For Paul, in the presence of the gym equipment, a physical prompt is given to his arm to approximate a push-away gesture. The prompt is given quickly to avoid problem behavior.

Sometimes it is helpful to use a most-to-least sequence of prompt delivery (see Chapter 4 for more on prompting). In a most-to-least prompt sequence, the interventionist delivers the level of prompt that is least intrusive but that consistently results in a response approximation. That prompt is then delivered immediately after the signal that reinforcement is available contingent on the learner’s production of the target behavior (SD). Once this history is established with no or little problem behavior occurring, the interventionist gradually reduces the magnitude of the prompt or implements a time delay fading procedure (see Chapter 4 for more description of these). Across successful opportunities, the magnitude continues to be systematically reduced contingent on continued correct responding until the response prompt has been eliminated. It is important that the communicative alternative be produced soon after the provoking event and prior to producing problem behavior. A most-to-least prompt hierarchy for many

Protesting as an Alternative to Avoidance‑Maintained Problem Behavior 111

learners best ensures that a chain in which problem behavior precedes the desired alternative behavior does not get reinforced. A most-to-least prompt hierarchy also tends to get reinforcement for a correct response to the learner quickly during the earliest phase of intervention. However, some learners find the delivery of an instructional prompt somewhat aversive (e.g., they prefer not to be touched). If this is the case, it may be necessary to gradually shape the learner to accept a physical prompt. For example, after the interventionist is able to gain close proximity with a provoking item, he or she can begin delivering a physical prompt by lightly touching the learner’s arm. Across successive successful opportunities, the physical prompt may become increasingly intrusive until the interventionist is able to apply enough contact to prompt a more complete response approximation. Even though the intervention strategy described has been designed to be as errorless as possible, it is likely that an occasional error in the form of problem behavior will occur. When problem behavior is produced, it is important to make it as inefficient as possible to result in escape. Doing so can be a formidable challenge. The most efficient strategy in the event of the production of problem behavior is to implement escape extinction (Iwata, Pace, Cowdery, et al., 1994). This means not allowing the learner to escape the situation. Escape extinction is relatively straightforward to implement when the problem behavior is not particularly severe and fairly easily interrupted. Consequently, the child learns that using the communicative replacement is the most efficient path to escape an activity, and appropriate communication occurs more quickly and is higher in the response hierarchy than are problem behaviors (Richman et al., 1999). Unfortunately, escape extinction can be problematic in that implementing it could place the interventionist in a dangerous situation if the learner is aggressive, or more severe forms of self-­injury might occur during an extinction burst. Make sure that you have a crisis management plan in place prior to implementing escape extinction. One option to consider is combining escape extinction with a dense schedule of NCR (also see Chapter 3). Reed, Ringdahl, Wacker, Barretto, and Andelman (2005) showed that NCR could be used to reduce bursts in problem behavior but not disrupt manding. NCR reduces the MOs related to escaping a task because “breaks” from the task are scheduled and, in this case, occur frequently. These scheduled breaks reduce the motivation to engage in behaviors maintained by negative reinforcement. If problem behavior always encounters escape extinction, but appropriate communication is often prompted and then reinforced, we would expect that over time, appropriate communication would occur much more often than problem behavior.

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Fade Instructional Prompts Across successful teaching opportunities, response prompts can be faded systematically and as quickly as possible. Below are several options commonly implemented in fading response prompts (refer to Chapter 4 for additional description). To decrease the magnitude of the instructional prompt, the interventionist could begin releasing the child’s hand or arm earlier and earlier across successive successful teaching opportunities. When Paul is using the push-away gesture as a protesting response with prompting, the interventionist can begin to prompt him and release Paul’s arm before completing the prompt (most-to-least restrictive prompt). Over successive teaching opportunities, the interventionist can release Paul’s arm earlier and earlier.

To delay the delivery of the instructional prompt, the interventionist could begin to implement a delay between the presentation of the undesired item/activity and the physical prompt (time delay prompt fading). This delay can be increased over successive successful teaching opportunities until the child is emitting the protesting response independently. When Paul is using the push-away gesture as a protesting response with prompting, the interventionist can delay the prompt briefly to see whether he will independently produce the protesting response.

Considering Spoken Language For learners who are acquiring spoken language and are proficient at imitating a spoken model, a prompt can be delivered from a farther distance than for children who use a graphic or gestural communication mode and require a physical prompt to emit the response. If it is necessary for the interventionist to be within close range of the child for a prompt to be delivered, one may implement two-­person prompting procedures or wait until the child tolerates the item at a distance that will enable a prompt to be delivered. Over time, the interventionist may begin to bring the undesired item or activity increasingly closer to the child, still removing the item prior to the emission of problem behavior. This would entail gradually decreasing the critical distance that was determined in step 1. For example, if on days 1, 2, and 3 Paul tolerated the item at a distance of 4 feet, then on day 4 the interventionist may decrease the critical distance to 3.5 feet. If Paul continues to

Protesting as an Alternative to Avoidance‑Maintained Problem Behavior 113

tolerate the undesired item at this distance, it can be decreased again (e.g., 3 feet) until the interventionist can get close enough to him to prompt the protesting response.

Summary Protesting is a communicative act that can be taught as an efficient alternative to problem behavior that functions to avoid activities. The selection of a protesting communicative alternative is made when the learner’s desire to escape or avoid an activity can be negatively reinforced. Essentially, the interventionist agrees to reinforce the function associated with problem behavior if the learner will use a more socially acceptable protesting act. Teaching socially acceptable protests represents an important communicative function. In this chapter, we have emphasized that protesting must almost always be established in combination with other antecedent-­based intervention strategies and with extinction. This is because it is likely that successful establishment of a protesting communicative act will result in the learner attempting to use it in situations where an escape/avoidance social function cannot be directly honored (reinforced). In our description of procedures, we have emphasized the immediate importance of decreasing the problem behavior in the presence of the provoking activity. We have also emphasized the importance of minimizing the production of problem behavior throughout the intervention process.

Chapter 6

Teaching Requesting Assistance

An assistance request can be produced when an activity is either too dif-

ficult or takes too long to complete independently. The reinforcement associated with the completion of a task or activity might be positive (e.g., requesting help with dressing so one can then go outside to play) or negative (e.g., requesting help to finish a difficult or boring task). Providing socially acceptable strategies to request assistance has been demonstrated to reduce problem behavior that is maintained by escape, as well as problem behavior maintained by obtaining access to desired events (Reichle, Dropik, Alden-­ Anderson, & Haley, 2008; Flood & Wilder, 2002; Jayne, Schloss, Alper, & Menscher, 1994; Reichle, Drager, & Davis, 2002; Reichle & McComas, 2004; Reichle et al., 2005).

The Development of Requests for Assistance In addition to its potential efficiency in addressing specific functions of problem behavior, requesting assistance is also one of the earliest communicative functions to arise in the repertoires of young learners (Crais et al., 2004). Prior to speech, toddlers typically learn a range of actions that have, in the past, resulted in obtaining help. For example, the child might recruit help with fixing a broken toy by bringing it to the adult or shifting gaze between the broken object and the adult. If that strategy is unsuccessful and the motivation for playing with the toy continues, the learner might then attempt to repeat his or her initial behavior by moving closer to the adult and pulling him or her, seeking out another listener, or intensifying his or her behavior to a tantrum (Alexander, Wetherby, & Prizant, 1997; Brady & Halle, 2002; 114

Teaching Requesting Assistance 115

Wetherby, Alexander, & Prizant, 1998). Such strategies may have been reinforced historically because they are relatively easy for adults to interpret. Interestingly, we know very little about the order in which learners are apt to use multiple strategies that may be part of their same response class. For example, they may be person specific based on history of reinforcement (e.g., physically leading results in ignoring from mom and tantrumming results in the delivery of punishment—­however, with dad, leading may usually work, but if it does not, a tantrum almost always works). The order of strategies may also be setting specific. For example, tantrumming does not work at home, but it almost always works at a restaurant where the embarrassment factor (MO for escape) for mom and dad may be maximized. Although many beginning communicators have an array of different appropriate and inappropriate communicative forms, many individuals with significant developmental disabilities may have a more limited range of prelinguistic behaviors that may also, in some instances, be less transparent for listeners to interpret. For example, a child might attempt to recruit help in opening his or her lunch box by vocalizing and rocking from side to side. Although this action might be recognized by a parent as an indication that help is needed, teachers might not associate such behaviors with a request for help. The behavior might then fail to recruit reinforcement at school, and could thus escalate into more severe problem behavior such as a tantrum. Again, the learner will likely first engage in behaviors that have a history of reinforcement, and so if an action such as rocking is reinforced at home, it may also occur at school. If this behavior is not reinforced but the motivation for the functional reinforcer continues, then the individual will begin to engage in other behaviors, including problem behaviors that have a history of reinforcement. Additionally, as individuals with significant disabilities get older, they are more likely to encounter a wider range of less familiar listeners. Thus, prelinguistic acts that are difficult to interpret are increasingly likely to become less effective as the learner encounters an increasing number of less familiar communicative partners. Although in many cases context will help listeners interpret such prelinguistic acts, there are still likely to be many instances when the context is not sufficient to enable the listener to interpret a learner’s communicative utterance (Stephenson & Linfoot, 1996). In this scenario, problem behavior might reoccur in other environments as well (showing resurgence), even if it has not occurred for a very long time.

The Range of Situations That Support Requests for Assistance As mentioned at the outset, requests for assistance can represent several distinct social–­communicative functions, such as gaining something preferred

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(e.g., tangible—­gaining assistance to unwrap a birthday present) or to terminate an aversive activity (e.g., escape—­requesting help with homework). Because both of these functions can be associated with requests for assistance, determining the function that is relevant for the child (see Figure 5.2 in Chapter 5 for an example of a brief functional analysis) and the context become potentially critical variables related to the success of any intervention to teach assistance requests. With a rudimentary communicator (who may have difficulty with representational symbols), it is important to ensure that there is sufficient context for a communicative partner to discern which social function the learner is attempting to address with a communicative act intended to request assistance. With respect to requesting assistance to access preferred items/events, consider 3-year-old Jana, who experienced significant developmental disabilities. Jana loved to go grocery shopping with her mom, mainly because she was always allowed to get a small toy from a vending machine near the exit. Often, these toys were wrapped within a hard plastic egg case. Jana usually struggled to open the egg case for 15–25 seconds, after which she would begin to tantrum (crying, stomping, and throwing the toy). Teaching a request for assistance prior to a tantrum resulted in the quickest way to obtain access to the vending machine toy.

Jayne et al. (1994) described an intervention approach that might be implemented for situations such as those encountered by Jana. They worked with two 8- to 10-year-old learners with moderate disabilities. During instruction, both engaged in disruptive behavior. When they were prompted to engage in a difficult activity, disruptive behavior was frequent. However, when the cue to request assistance was inserted into the prompting procedure, disruption was reduced. These results demonstrated a clear relation between learning to request assistance and reduction in disruptive behavior. As mentioned previously, assistance can of course be needed in a large number of different contexts, and problem behavior may serve a very different social function than accessing desired items. However, when the function is to gain something preferred, teaching the learner how to make that request should be a successful strategy in most circumstances. In other contexts, such as when a learner might seek assistance to more quickly complete an aversive task (e.g., cleaning the floor), the social function of the learner’s communicative overture is escape. Consequently, requesting assistance is one of those communicative functions that can serve several very diverse social functions, which, in part, is what can make it a challenging intervention objective. In the next sections of this chapter, we address implementing procedures to teach requesting assistance, followed by a discussion of some of

Teaching Requesting Assistance 117

the generalization challenges that can arise along with ways to minimize those challenges.

The Importance of General Case Instruction in Teaching Assistance Requests The topic of generalization is directly pertinent not only to requesting assistance but also to any communicative alternative to problem behavior being taught. As pointed out in Chapter 3, a general case instructional strategy helps to ensure that a sufficient range of teaching examples has been considered. At the same time, it helps to ensure that the learner is exposed and responds appropriately to a range of stimulus characteristics that should not be associated with a response being taught. Having a sufficient range of positive (where the response being taught should be produced) and negative (where the learner should refrain from producing the response) teaching examples should maximize the discriminative use of the new skill, while maximizing desired generalization. General case instruction represents a particularly important consideration in that once children learn a new communicative response, there may be some unanticipated generalization. For example, Schieltz et al. (2010) conducted functional analyses and reinforcer analyses for children with developmental disabilities who displayed severe problem behavior. They showed that the functions for communication and problem behavior often did not match, because the children emitted the communication response for a greater range of consequences than they displayed problem behavior to obtain. We encourage the reader to carefully review our discussion of general case instruction prior to proceeding with the remainder of this chapter. In describing generalization challenges that those learning to request assistance frequently encounter, it becomes clear that the problems identified could be greatly minimized through a judicious choice of teaching examples. First, we discuss evidence supporting explanations of several common generalization challenges. Subsequently, we outline procedures that we have found useful in teaching assistance requests.

Generalization Limitations as a Challenge to Response Efficiency As described previously, it is possible that the learner will fail to generalize. Although there are many reasons why the learner may not generalize (or maintain) a newly taught communicative replacement behavior, failure to generalize can occur because the alternative response is not as efficient as the former behavior (at least from the learner’s perspective)—that is, problem behavior may be more quickly and consistently reinforced than the

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newly taught alternative. In Chapter 1, we discussed variables that influence response efficiency, which have been well articulated in the empirical literature. Alternatively, it is possible that in some settings or with some individuals the problem behavior continues to be reinforced, but in a different setting or with a different individual the problem behavior is not reinforced. This, too, could account for some generalization challenges. It is possible that newly acquired assistance requests can be under control of the stimuli that were associated with both positive (e.g., to gain assistance opening a package) and negative reinforcement (e.g., to speed the completion of an undesirable event). However, in comparing the efficiency of existing problem behavior with that of newly acquired socially acceptable requesting assistance, problem behavior might have been the more probable one maintaining reinforcers because it had a longer and stronger history of continued reinforcement (at least intermittently) in a given situation. An example of the outcome that can occur from a range of teaching opportunities that is too narrow was presented by Drasgow et al. (1998), who taught each of three young learners with severe language delays to request food, toys, and events. During baseline probes, each learner requested by reaching, grabbing, or leading his or her communicative partner. Subsequently, the learners were taught to request appropriately in a school setting. Post-­acquisition probes demonstrated maintenance of the old requesting forms in a generalization environment not associated with original intervention. Subsequently, following extinction of the old forms (interventionists refrained from delivering toys when the learner engaged in old forms), reinforcement of the replacement behavior was implemented in the generalization setting. Two of the learners substantially increased their use of the new communicative form, and the remaining learner demonstrated a moderate increase. The outcome of this study suggested that generalization might involve more than the association of an existing response form with a new stimulus situation. Instead, explicit instruction or intervention may be needed. Additionally, the relative reinforcement associated with each response may need to be clearly differentiated. Findings such as those described by Drasgow et al. (1998) suggested that when a competing behavior was made less efficient, the learners used their newly established behavior. A number of variables influence the likelihood that a communicative response taught in one context or situation will be produced in a different situation. For example, it is possible that when the schedule of reinforcement for problem behavior in a generalization environment is different than it is in an acquisition environment, generalization may be less likely to occur. This is because the strength of problem behavior is higher in the generalization environment and thus it persists longer than it did in the acquisition

Teaching Requesting Assistance 119

environment. A similar problem in terms of generalization may occur across maintaining variables. If problem behavior as an assistance request has been more apt to be reinforced to obtain positive reinforcement (opening a package) than with negative reinforcement (to speed the completion of an aversive activity), the former may be more resistant to replacement with a communicative alternative. As long as problem behavior continues to be efficient, a learner would have no reason to switch to the use of a more socially acceptable response. The preceding observation was noted by Mace and Roberts (1993), who were among the first applied behavior analysts to articulate that behavior represents a choice response. Choice, in turn, is dictated by reinforcement history and the current probability of receiving reinforcement. Some forms of generalization may be less likely to occur without specific training. This is why it is important to teach the desired communicative response in at least one example of each context or situation in which we hope it will occur. For example, requesting assistance likely needs to be taught in both a tangible and a demand context. If this is unsuccessful, and as recommended by Berg et al. (2007), then a second example should be trained in each context. Stokes and Baer (1977) reported that two examples (in this case, within a stimulus context) are often sufficient for generalization to occur. One important aspect of functionally using requests for assistance involves being able to discriminate when the newly acquired request should be used. One of the most basic discriminations involves learning to use an assistance request when the learner cannot competently perform a task. Alternatively, when the learner is competent to perform a task, the learner should either (1) engage in the task, if the reinforcement for engagement is sufficient; (2) request a break if the task is too long; or (3) protest when the task is offered, if the task is nonobligatory. Teaching the conditional use of communicative responses, such as requesting assistance, has been studied less than the emission of mands during FCT. Reichle et al. (2005) described an adult with significant developmental disabilities who was taught to request assistance to compete with problem behavior that was associated with escape from difficult activities. Eric, a 40-year-old man with autism and severe intellectual disability, had a communicative repertoire that consisted primarily of loud vocalizations, pointing to desired objects/items, and a number of idiosyncratic gestures. He also used 10 black-and-white line-drawn symbols located in a wallet to request specific food items. A brief assessment indicated that he used each of these symbols functionally. Although Eric had been working on a number of daily living and vocational tasks for many years, his progress was limited. Specifically, group home staff reported that Eric had difficulty completing vocational tasks that included simple assembly and packaging work.

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Interventionists implemented training within a multiple-­probe design across tasks, with each of three different tasks that were required to complete a job. All three tasks were probed concurrently during baseline. Intervention was then implemented with the first task while the other two tasks remained in baseline. As soon as training had clearly improved performance on the first task, intervention was implemented with the second task, and as soon as performance on the second task had improved, instruction began on the third task. This single-­case design helped to control for (understand the effects of) the passage of time and other variables in the environment that may have had an inadvertent impact on performance. When Eric was proficient in independently assembling the last component of the task, intervention on the second component of the three-part task was implemented. When he mastered the second component, intervention was implemented on the first component of the task. Concurrent probes for independent work and requests for assistance were implemented on all three legs (components) of the multiple-­probe design. To determine when to reduce the level of interventionist assistance provided following a request for assistance, the interventionist occasionally conducted probes utilizing a less intrusive form of prompting. If Eric responded correctly given this new level of prompting, increasingly less intrusive prompts were implemented with the goal of completely eliminating response prompts. Daily sessions consisted of three teaching opportunities during which the interventionist placed graphic communication symbols near the assembly materials, pointed to the work symbol, and said, “Time to work, Eric.” After providing this cue, the interventionist’s actions were dictated by the level of prompt implemented during the mostto-least prompt hierarchies being implemented. One hierarchy dictated the nature of the prompt given to encourage Eric to use the “help” symbol. A second most-to-least prompt hierarchy established the level of actual assistance provided by the interventionist that resulted in successful engagement of the task step being taught. At the onset of a teaching opportunity, the interventionist waited several seconds before delivering a prompt to the request assistance symbol. Following each teaching opportunity (i.e., when the pipes and fittings had been assembled), Eric was allowed to select a reinforcer from an array of edibles. The reinforcer was delivered regardless of whether Eric assembled the pipes himself or completed the task with requested assistance. After Eric consumed his reinforcer, the next teaching opportunity was initiated. Eric learned to request assistance independently and to complete the three-piece assembly task independently. As he became increasingly more skilled at the assembly task, he began to refrain from requesting assistance and instead completed the task independently.

It is plausible that the shift in Eric’s response strategy was related to differing lengths of time that were required to complete the task when

Teaching Requesting Assistance 121

assistance requests were compared with independent task completions. Although this relation was not experimentally verified, task duration data were examined in a post hoc analysis. When Eric completed the task independently, the mean time to completion and thus to positive reinforcement was substantially decreased. Initially, requesting assistance resulted in much quicker task completion than engaging in problem behavior (given that Eric was not allowed to leave the area until participation was completed). When he became increasingly independent in performing the task, Eric was able to gain release from the task more quickly than he could by requesting assistance. Making reinforcement associated with independent responding to be obviously more efficient than requesting assistance may be an important strategy for interventionists with at least some learners. Researchers such as Hanley et al. (2001), reported that some learners mand at very high levels after they have acquired independent communication skills. Making task completion more reinforcing than, for example, requesting assistance, can reduce overall rates of manding. Wacker et al. (2011) described a second option based on Fisher et al. (1998), which is to signal when communication will be reinforced. The learners in the Wacker et al. (2011) study all had escape-­maintained problem behavior. Each was taught to complete a task and then to request a break by pressing a microswitch on a speech-­ generating device. Speech output was available only when the task was completed and the learner pressed the switch (which in turn produced the break request). The presence of the switch provided a visual cue that manding would produce enriched breaks from the task. As mentioned previously, we use this approach for learners who are motivated to escape the task. Fisher et al. (1998) and Hanley et al. (2001) described an additional advantage of signaling when communication will be reinforced: schedule thinning. Schedule thinning refers to the reduction of the rate of a response (in this case, communication) via the reduction in the rate of reinforcement. As learners become increasingly independent in communicating, it then becomes important that they regulate their use of communication (i.e., conditional use), including their overall rate of communicating (see Chapter 8 for an example with attention-­maintained problem behavior). Signaling when reinforcement will be available for communicating allows the interventionist to reduce the learner’s overall rate of making repeated requests. In teaching Eric to request assistance, the interventionist’s ability to examine conditional use of requests for assistance was limited. The only teaching examples used were ones that, as he became more competent, switched from stimuli signaling the occasion to use a request to stimuli signaling the occasion to work independently. An important question is “What happens when a learner encounters new problems that were not

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previously part of training, particularly when there are some that are difficult and others that should be easy?” To address this question, a second case study implemented a similar procedure with an elementary school student who engaged in problem behavior to escape engagement in math worksheets. Reichle and McComas (2004) reported on Timothy, a 12-year-old third grader being served in a regular elementary school classroom. He had been described by a school psychologist as having behavior disorders and experiencing mild intellectual disability. Academically, Timothy was approximately two grade levels delayed in reading and math. His teacher reported that he engaged in high rates of problem behavior to escape/avoid task demands. A functional assessment interview with his teacher revealed that task demands associated with worksheets were likely to result in property destruction and/or aggression directed at educators. An ABC analysis (Bijou, Peterson, & Ault, 1968) consisting of environmental manipulations, demonstrated that a substantial portion of his problem behavior functioned to escape difficult work. Subsequently, a functional analysis demonstrated that when assistance was provided as Timothy encountered a difficult problem, problem behavior was less likely to occur. Consequently, interventionists taught Timothy to request assistance as an alternative to his escape-­maintained problem behavior. During each intervention opportunity, the interventionist gave Timothy a worksheet containing 10 problems. The interventionist told Timothy that if he placed his pencil on each problem and tried to solve it but was unsuccessful, he could ask for assistance. Additionally, he was told that math would not be over until the worksheet was completed and that he could not leave until it was finished (this is a form of escape extinction, because the interventionist made it difficult for Timothy to leave until he completed the math problems). In the description that follows, a number of different prompts were utilized. Each of these is summarized in Table 6.1. As Timothy looked at the worksheet, the interventionist immediately asked, “Want some help?” If he nodded, the teacher said, “Raise your hand,” as she raised her hand to model the correct response. Contingent on a hand raise, the teacher quickly worked through the problem with him. After five consecutive prompt-­pairing opportunities, the interventionist implemented a 5-second constant time delay. If Timothy raised his hand within 5 seconds of encountering a problem, assistance was provided. If he did not raise his hand, a verbal prompt to do so was delivered. The presence or absence of each of these behaviors during each worksheet problem was recorded by the interventionist. If at any point during the intervention Timothy attempted to leave his seat, he was redirected to his seat and the task was reimplemented until it was completed. Although intervention procedures were successful in replacing problem behavior with a functional communicative alternative, the intervention protocol was

Teaching Requesting Assistance 123 TABLE 6.1.  Types of Response Prompts Type of prompt

Example

Gestural

Pointing to a worksheet to direct the Timothy’s attention to it.

Verbal

Saying “Want some help?” and then says “Raise your hand.”

Visual

Showing a visual symbol representing a learner raising his or her hand.

Model

Saying “Raise your hand” and model raising of hand.

Partial physical

Pairing a verbal prompt with a touch on Timothy’s hand to encourage him to raise his hand to request assistance.

Full physical

Raising Timothy’s hand.

unsuccessful in establishing improved independent performance in solving more difficult math problems. Interventionists hypothesized that Timothy had requested assistance on every teaching opportunity because doing so was easier than solving problems on his own. They also concluded that he did not appear to be attending to the model of problem solution that occurred as the interventionist delivered assistance. Consequently, the interventionist implemented two subsequent intervention phases. In one, interventionists chose to teach Timothy to solve problems during a context in which there was no need to request assistance. During errorless instruction, Timothy’s interventionist conducted additional tutoring sessions in the classroom. He was introduced to a Magna Doodle, a device that displays a black background. When a stylus is moved across the background, rainbow colors are revealed. Timothy was observed to play with the Magna Doodle for periods of up to 30 minutes. During each session, individual sets of 10 problems were placed in front of Timothy. He was told that problems had to be solved “on his own,” without asking for help. A rehearsal strategy was established to teach Timothy the “addition” skills that represented the “difficult” work contained in the math worksheets. First, the teacher modeled how to solve a carrying problem. After the demonstration, Timothy had 10 seconds to “beat the clock” by adding digits in the ones column and carrying by placing the carried numbers at the top of the tens column. If he did, he earned a point. Subsequently, he had an additional 10 seconds to add numbers in the tens column and record the number on the worksheet. Doing so resulted in earning another point. Each point earned was traded for 1 minute of Magna Doodle play at the completion of the

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session. If he emitted problem behavior, the interventionist did not allow him to escape from the task. During several early teaching opportunities when he was disruptive, the interventionist removed Timothy from the classroom but reintroduced the task in an adjacent empty office. When problem behavior is maintained by negative reinforcement, it is important that problem behavior never result in the removal or termination of the task. If behavior becomes so disruptive or difficult to manage that an exclusionary time out (i.e., removal from the current situation to an isolated situation) is needed, the task should either be also taken to time out or the learner should return to the task immediately following time out. Ideally, time out would never be used with escape-­ maintained problem behavior, because the removal of the learner does result in the immediate cessation of the task. Although this cessation is temporary, it might still be sufficient to maintain problem behavior, and result in FCT needing to be implemented for longer periods of time before reductions in problem behavior occur. For this reason, we recommend that escape extinction be used whenever possible. During a second step, the teacher implemented a constant time delay in which she waited 5 seconds before delivering a model. Across opportunities, the delay increased and the number of problems to solve increased. Contiguous with errorless instruction, periodic probes were implemented during the regularly scheduled math worksheet task that occurred during a different class period. During probes, a 10-problem worksheet containing problems that were the focus of errorless instruction was placed in front of Timothy. The same spoken instructions that were available during the original worksheet instruction were given. Although intervention was successful in teaching addition during regularly scheduled worksheet probes that were implemented contiguously with errorless learning, Timothy continued to request assistance (as he had prior to errorless instruction). He was not using his problem-­solving skills to complete the worksheet task. One explanation for Timothy’s overuse of assistance requests during the worksheet task was that it continued to be the least effortful strategy to get the task to end. During errorless instruction, a history of no assistance requests was established. However, during the worksheet task, a history of requesting assistance resulted in the best outcome for the least amount of effort. To further explore this possibility, a final phase of intervention was designed to increase the reinforcement value for independent work in an attempt to encourage Timothy to allocate a greater proportion of his responses in the worksheet task to independent task completion and fewer responses to requesting assistance. Prior to giving Timothy a 10-problem math worksheet, half (five) of the worksheet problems were ones for which he had demonstrated mastery during the implementation of the errorless program to teach him to solve addition problems that involved carrying. The remaining five were math problems that he had not yet been able to solve. The interventionist told Timothy

Teaching Requesting Assistance 125

that if he did his best and asked for help when he really needed it, he would be able to access the reinforcer that he had chosen. Timothy had an opportunity to earn a potent reinforcer if he requested assistance on the really hard problems, but independently completed the easy problems. Timothy met the criterion established and earned the reinforcer of his appropriate choice of independently completing mastered problems but requesting assistance with nonmastered difficult problems during each of four sessions. In doing so, he emitted a single error during opportunities with problems that had been targeted for independent completion. He was correct on all problems that had been targeted for requests for assistance.

Generalization of Assistance Requests across Communicative Functions As shown by Falcomata et al. (2013), communicative responses established to address one function of problem behavior (e.g., escape) may not generalize to different contexts (e.g., obtain/maintain access to attention or tangibles). Unfortunately, these results support other preliminary but not experimentally controlled evidence that suggests that teaching requests for assistance in one of the contexts described above may not necessarily guarantee that the request will be used in another context in which help is needed. Reichle et al. (2002) explored this issue of the generalizability of requesting assistance across social contexts that involved positive as well as negative reinforcement. Sam (not the same learner discussed in Chapter 5) was a 32-year-old man with severe disabilities. Although he occasionally vocalized loudly to obtain attention, he did not produce any intelligible words. His gestural communicative repertoire was limited to leading people to items that he wanted. If his communicative overtures did not result in an immediate response, he usually engaged in problem behavior. During the previous 10 years, Sam had been taught to use 20 Mayer–­Johnson black-and-white line-drawn symbols to request desired items. When asked to engage in difficult tasks at work or at home, Sam screamed and occasionally hit others who were nearby. Staff that worked with Sam described him as becoming easily frustrated “If he doesn’t get his way.” It was hypothesized that these behaviors occurred because in the past they enabled him to gain negative reinforcement in the form of escaping from difficult tasks. Sam also engaged in problem behavior after he had obtained a desired item but was unable to access it, such as when he was given a cassette player but could not insert the cassette tape, or when he was given candy that he could not unwrap. To address his problem behavior, prospective interventionists implemented a series of functional analyses to verify the social function(s)

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associated with Sam’s behavior. One functional analysis verified that problem behavior was associated with highly preferred but difficult-­to-­access items/activities. A second functional analysis verified that problem behavior was associated with difficult tasks that were physically problematic, but was not associated with physically less problematic tasks. A third functional analysis verified that providing unsolicited assistance in obtaining highly preferred items associated with problem behavior resulted in a decrease in problem behavior. A fourth functional analysis documented the same decrease in problem behavior when assistance was provided on a nonpreferred and physically difficult activity (i.e., problem activity). When unsolicited assistance was provided, Sam’s problem behaviors decreased dramatically in both preferred and nonpreferred difficult activities. Subsequently, interventionists implemented a procedure to teach requesting assistance. They attempted to address whether it was necessary to select teaching examples that included both highly preferred but difficult-­ to-­access items (positive reinforcers) and nonpreferred difficult activities (negative reinforcers) in order to produce generalized use of requests for assistance. The choice of teaching examples requires renewed consideration of our discussion in the previous chapter on protesting, in which we introduced general case instructional strategies as a rationale for choosing the most relevant teaching examples to ensure well-­discriminated yet generalized use of new communicative functions. With respect to Sam, interventionists implemented the procedure within a multiple-­probe design that consisted of three tiers. Initially, interventionists implemented intervention with a set of nonpreferred difficult activities. (Brief tutorials on single-­subject design are available in Cooper, Heron, & Heward, 2007; Byiers, Reichle, & Symons, 2012). Concurrently, a second set of comparable nonpreferred difficult activities remained in baseline, and a third set of preferred but difficult-­to-­access activities associated with problem behavior remained in baseline. Interventionists hypothesized that Sam would generalize his use of a new symbol for assistance requests to the second set of nonpreferred difficult activities but fail to generalize his newly acquired request for assistance to the group of preferred but difficult-­to-­access activities. This was based on the hypothesis that social functions of behavior may represent a generalization challenge, as differing perceptual features of objects can influence generalization (e.g., a child may identify a red apple as an apple but may not identify a green apple as an apple). The first two activities involved negative reinforcement. Thus, generalization was predicted because both activities involved negative reinforcement. The third activity involved positive reinforcement. Because the MOs and reinforcement classes were different for this third situation, generalization seemed to be less likely to occur. The outcome of this investigation is depicted in Figure 6.1.

Baseline

Intervention

100 90 80

Request Assistance Completed Task

70 60 50 40 30

Constant 5-sec time delay

20 10

Challenging Behavior

Difficult Tasks— Group A

0 0

1

2

3

4

5

6

7

8

9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

100 Percent of Opportunities

90 80 70 60 50

Difficult Tasks— Group B

40 30 20 10 0 0

1

2

3

4

5

6

7

8

9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

100 90 80 70 Preferred but Difficult-to-Access Tasks

60 50 40

Engaged in or Consumed Tangibles

30 20 10 0 0

1

2

3

4

5

6

7

8

9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Block of 10 Opportunities

FIGURE 6.1. Results of a multiple-­probe design involving two sets of nonpreferred difficult tasks and one set of preferred but difficult to access objects. From Reichle, Drager, and Davis (2002). Reprinted with permission from West Virginia University Press. 127

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The hypotheses were shown to be correct; generalization occurred for the second negative reinforcement situation but not for the positive reinforcement situation. Even though requesting assistance served as a functionally equivalent and an apparently efficient alternative to problem behavior, both of the social situations associated with Sam’s problem behavior and the propensity to use a request for assistance appeared to be influenced by the function of his problem behavior. Sam generalized his new assistance requesting symbol to previously untaught situations involving nonpreferred and difficult activities (the same function that was addressed during intervention). However, he did not produce his new requesting assistance symbol in situations that involved positive reinforcement (accessing preferred activities). For Sam, it appeared as if generalization occurred primarily for activities associated with negative reinforcement (no generalization was observed, even though several activities associated with positive reinforcement were delivered in the same setting, and problem behaviors emitted were topographically similar to those that had been associated with the teaching example involving escape from nonpreferred activities). It is possible that Sam’s narrow boundary of generalization was the product of a conditional discrimination in which a competing response (problem behavior) was a more efficient response than a request for assistance in situations that involved positive reinforcement. Very similar results with respect to generalization of communication replacement responses across positive and negative reinforcement contexts were reported by Falcomata et al. (2013). However, these investigators taught participants to request two different classes of positive reinforcers (attention and tangible) and one negative reinforcer (breaks from demands) in a sequential fashion. The results showed that generalization across the positive reinforcement contexts was much more likely to occur than from positive to negative reinforcement. Falcomata et al.’s (2013) outcomes suggested generalization across positive reinforcement classes, whereas Reichle et al. (2002) showed generalization across negative reinforcement classes. Several years ago, we worked with Tommy, who engaged in aggression toward others when he encountered difficult tasks that he could not complete independently. He hit others when he was asked to put his toys away (physically demanding). During a functional assessment, his teacher discovered that small objects that required a pincer grasp were difficult for Tommy to pick up. Most of his problem behavior occurred when he encountered very small objects. Tommy’s teacher established a program in which a prompt was delivered for him to produce “help” when he approached a small item. Across opportunities, the prompt was faded by progressively delaying the delivery of the prompt. Unfortunately, most of the teaching examples involved activities

Teaching Requesting Assistance 129

that he did not particularly enjoy. Interventionists did not consider that some small objects that require fine motor skills also involve gaining access to desired items. Interventionists quickly realized that Tommy also engaged in property destruction when he could not quickly access desired items that required opening a container or unwrapping. After briefly trying to remove a Happy Meal toy from its cellophane wrapper, he would throw it across the room. Initially, Tommy’s parents implemented intervention at McDonald’s. As soon as they offered him a toy, they extended an arm and delivered a physical prompt to return the toy. His parent immediately unwrapped and returned the toy to Tommy. During any instances in which Tommy began engaging in property destruction, the toy was removed and up to a 30-second delay was imposed before he again had access to the toy. For Tommy, positive teaching examples for teaching assistance requests needed to involve situations in which he gained access to desired items, as well as to items/activities that were not among his favorites and that were difficult to complete independently.

In Tommy’s case, when his parents quickly removed the wrapper contingent on problem behavior, his problem behavior was reinforced. Our basic rule of thumb is that we do the opposite of what we hypothesize the learner wants contingent on problem behavior. Additionally, if Tommy engages in problem behavior in an effort to obtain access to a desired item, time out or other consequences may assist Tommy in learning to discriminate what happens when he engages in a desired behavior compared with what happens when he fails to engage in that behavior. Note that the consequence when problem behavior does occur need not be long or very severe. The key is that the consequences of problem behavior be matched to the function of problem behavior and be delivered as soon after problem behavior occurs as is possible. As soon as Tommy calmed, the item was reoffered. After approximately 15 opportunities, Tommy began to offer wrapped toys to his parents. When offered an unwrapped toy, he almost always began playing with it without offering it to his parents. In the example just provided, Tommy acquired the conditional use of requesting assistance. Therefore, when a wrapped toy was offered, he requested assistance, and when an unwrapped toy was offered, he played with it. A way to further minimize the need for implementation of a consequence for problem behavior can be part of an intervention package in situations where an interventionist can anticipate that problem behavior could occur. For example, unwrapping a small candy is likely to be a problem for Tommy. Thus, prompting him to produce an assistance request prior to engagement in problem behavior will reduce the probability of any problem behavior, and therefore the need to implement a consequence contingent on the occurrence of problem

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behavior. In addition, by teaching him to make the request, we are also providing instruction on an important skill, FCT, rather than simply preventing the problem behavior from occurring at all. Effective behavioral intervention has occurred when the learner has the opportunity to emit problem behavior, but instead chooses to engage in a more appropriate behavior such as communication. If we only prevent problem behavior from occurring—­for example, by unwrapping all candy prior to giving it to Tommy—then Tommy never learns to self-­regulate his behavior and to choose to emit an appropriate alternative behavior. Too many individuals appear to focus on preventing the problem behavior by anticipating the learner’s needs. Of course, this strategy breaks down whenever the learner encounters social partners who are not extremely familiar with the learner’s wants and needs. Our discussion in this section of the chapter suggests that interventionists should carefully consider the range of social functions that may be associated with a particular assistance request from the outset of intervention, and be prepared to teach the learner to emit that response in every relevant context. Intervention should continue until it has been shown that stimulus generalization has occurred. Stokes and Baer (1977) suggested that generalization has occurred under either of two conditions: (1) no additional training is needed in the generalization condition (different person, setting, or task), or (2) substantially reduced training is needed. Thus, if substantial reductions in training time occur, it has been demonstrated that some generalization did occur. Fortunately, stimulus generalization across people and settings (and to a somewhat lesser degree, across tasks) often occurs with FCT. Berg et al. (2007) evaluated the stimulus generalization that occurred with FCT in a negative reinforcement context. The participants were young children with developmental disabilities who displayed severe problem behavior. All procedures were conducted in the children’s homes by their parents with coaching provided by applied behavior analysts. A functional analysis was first conducted that showed that negative reinforcement in the form of escape from demands was the maintaining reinforcer. The children were taught to complete a small portion of the demand and then to request a break. The stimulus context was the parent, the room in the house where training occurred, and the specific demand. For each of these situations, probes were collected on three other stimuli. For example, the person delivering the same demand in the same location might be the grandmother, a respite provider, and the teacher. The location in which the parent delivered the same demand might have been the grandmother’s house, the outpatient clinic, and the school. The demands were different academic and self-care tasks. Probes of all nine of these situations were conducted both prior to and following FCT. The results showed that FCT often produced good

Teaching Requesting Assistance 131

generalization effects. Generalization without further intervention was achieved most often across people and settings. Generalization across tasks almost always involved additional training, but substantially less intervention. The study by Berg et al. (2007) and others (e.g., Durand & Carr, 1991) shows that when sufficient exemplars are well established, FCT can produce stimulus generalization within functional response classes. However, rather than conducting FCT and hoping that generalization will occur, it is best to evaluate its occurrence and better yet to develop and implement an intervention strategy that addresses its occurrence. Stokes and Baer (1977) provided examples of procedures that can be used to program for generalization, and each has been shown to be effective in the literature. In the next section, we describe general case instruction that has proven to be effective for us (e.g., Wacker et al., 2005). General case instruction is a variation of the sufficient exemplars procedure that, originally, was described by Stokes and Baer (1977).

A Guide to Teaching Requesting Assistance1 Getting Ready to Teach Requesting Assistance Assuming that a functional assessment has been successfully implemented demonstrating that problem behavior was escape maintained, and also assuming that the MO related to problem behavior has been identified and shown to be related to negative reinforcement, the interventionist will have identified the critical event that sets the occasion for escape-­motivated behavior. Prior to teaching an assistance request, it is helpful for the interventionist to demonstrate that providing assistance results in a deceleration of the learner’s problem behavior. For example, to address Tommy’s escape behavior, a brief functional analysis comparing two different conditions was implemented when he refused to pick up toys. In one condition, the 1 The

description of the procedures that follow were adapted from “Communicative Replacement Strategies for Challenging Behaviors tThat Serve the Function of Avoid/ Escape: Assistance Requests,” Principal Investigators Joe Reichle, PhD, and Mary ­McEvoy, PhD, and Co-­Investigator Carol Davis, EdD, University of Minnesota. This project was supported in part by Grant Nos. HO24D40006 and H024P10017 from the U.S. Department of Education to Joe Reichle, PhD, and Mary McEvoy, PhD, at the University of Minnesota. Contributors included; Mary Ann Marchel, Laura Moore, ­Shelley Nielsen, April O’Keefe, Melissa Olive, Amy Richardson, Rebecca Smith, ­Kathleen Wolff, Robert Utke, Kathryn Drager, Susan Johnston, Kathleen Feeley, Michael Harris, Elisabeth Rogers, Virginia Traylor, Sandy Charron, Amy Hicks Marquez, Gretchen Jackson, Karen Anderson, Judy Bartlett, and Kayleen Vieberg.

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interventionist provided no attention and no assistance. In a second condition, unsolicited assistance (with no other accompanying attention) was provided as soon as he disengaged. By comparing Tommy’s engagement in the activity after the delivery of the assistance and whether he engaged in problem behavior, the interventionist could determine whether assistance provided prior to problem behavior resulted in less problem behavior and in task continuation when compared with no delivery of assistance. To rule out the possibility that Tommy simply wanted the interventionist’s attention, a second functional analysis was completed. In one condition, no assistance but a lot of positive attention was delivered in the context of continued task demands. In the second condition, unsolicited assistance was provided with virtually no other attention when Tommy reached a difficult task step. If less problem behavior occurred in the latter condition, requesting assistance might be a good option. Note that, in the preceding example, the functional analysis utilized events that occurred prior to the learner’s challenging behavior; this was an antecedent manipulation. This manipulation showed that receiving assistance altered the MO associated with escape-­maintained problem behavior. One could also have performed a consequence manipulation in which consequences after the emission of the challenging behavior were manipulated. As discussed by Hanley et al. (2003), both comprise a functional analysis. Consequence manipulations provide a more compelling link to causal relations than do antecedent manipulations. However, antecedent manipulations can often be arranged so that the emission of the challenging behavior is decreased because of changes to the MO.

Define the Range of Activities in Needing Assistance (Identify the MOs Related to Problem Behavior) Direct observation while the learner is engaged in a variety of activities may help to identify activity components that are difficult/problematic/nonpreferred for the learner and that may seem to consistently trigger escape/ avoidance behavior. One way to do this is to task analyze the activity and document whether the learner is able or willing to engage in each step independently. Lisa is a young girl who engages in problem behavior (hair pulling) when she encounters a difficult step in an activity. She has been observed to pull her hair during morning meeting, whole-class instruction, and in the bathroom.

The interventionist may decide whether to address a number of activities at the same time or to concentrate on one activity at the onset of implementing an intervention strategy.

Teaching Requesting Assistance 133

Lisa’s interventionist, Matthew, decided to begin with one problem activity. She was observed during morning meeting. As Lisa sat down on her designated spot on the carpet, Matthew noted the steps that she was able to complete independently and at what point she was in need of assistance. The data revealed that Lisa independently accomplished each step in the morning meeting routine (i.e., sit down, turn to neighbor to say “Good morning,” say “Good morning” in unison with teacher) until it came time to identify the day of the week and the date. At this point, she began to pull at her hair, first a few strands, and then violently. This pattern occurred consistently across 6 days.

Figure 6.2 shows the data form that was used to collect this information about Lisa.

Identify Specific Activities That Can Serve as Positive and Negative Teaching Examples It is likely that an individual encounters many activities during the course of the day in which a request for assistance might be helpful. Determining the range of positive teaching examples involves identifying the range of Student name:  Lisa  Observer: M. C. Activity:  Morning meeting

Step in Activity Sits on assigned spot on carpet

Session Problem Behavior(s) 1/17 1/18 1/19 1/20 1/21 1/24 Totals Hair pull

–

–

–

–

–

–

0/6

Turns to neighbor Hair pull and greets

–

–

–

–

–

–

0/6

Greets teacher

Hair pull

–

–

–

–

–

–

0/6

Says date and day of the week

Hair pull

+

+

+

+

+

+

6/6

Says the weather outside

Hair pull

–

–

–

–

–

–

0/6

Reviews daily schedule

Hair pull

–

–

–

–

–

–

0/6

FIGURE 6.2.  Requesting assistance observation form for Lisa.

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FUNCTIONAL COMMUNICATION TRAINING FOR PROBLEM BEHAVIOR

activities in which it is important for the learner to request assistance, and all interventionists can diligently implement an agreed-­upon intervention strategy. Next, identify a range of occasions in which the learner should refrain from engaging in the requests for assistance (see Table 6.2). Unfortunately, interventionists are not always able to take advantage of all potential teaching examples identified. It is important to select those instances that reflect a reasonable range of opportunities that represent the conditions in which the interventionist would like to see the behavior used. With requesting assistance, it may be important to pick some positive teaching examples that are associated with obtaining access to desired items/activities, as well as positive teaching opportunities that address situations in which the learner is attempting to escape difficult tasks. The same rule may be important in selecting negative teaching opportunities. During these opportunities, the learner should refrain from using a request for assistance.

TABLE 6.2.  Instructional Universe for a Request to Obtain Assistance Response Appropriate response

Rationale for response

Positive examples Learner encounters a difficult task.

Learner points to the graphic symbol “help.”

Use of the graphic symbol will result in the interventionist determining learner’s motivation to obtain assistance.

While at home in the presence of family members, learner requires assistance in order to gain access to a preferred item.

Learner signs “help.”

Producing the sign for “help” results in parent’s delivery of desired assistance (due to parent’s comprehension of signs).

Negative examples Learner encounters a difficult task in the presence of an adult who is occupied.

Learner refrains from requesting assistance and refrains from attempting to complete the task.

In situations where needed assistance cannot be provided to learner, he or she should refrain from producing the requesting response.

Learner encounters a step that he or she can perform independently.

Learner attempts the step and refrains from requesting assistance.

In situations where assistance is not needed, learner should refrain from producing the requesting response.

Teaching Requesting Assistance 135

Consider the Efficiency of the Communicative Alternative To ensure that the communicative replacement is efficient from the learner’s perspective, it is essential to consider the efficiency of the communicative response in relationship to the learner’s existing communicative means. Table 6.3 provides examples of aspects of response efficiency.

Determine the Point in the Activity at Which the Learner Is Likely to Engage in Problem Behavior Carefully observe the exact point at which the learner engages in problem behavior or engages in the first of a chain of behaviors that lead to problem behavior. Linda, Sharif’s interventionist, used the recording system (see Figure 6.3 on p. 137) to observe that Sharif struggled with opening his supply box that contained pencils and markers. The shortest amount of time that he attempted to open the supply box before engaging in problem behavior was 3 seconds.

Implement the intervention at a point that predictably occurs prior to problem behavior.

Consider Ordering the Teaching Examples to Ensure Generalized and Conditional Use of Requests for Assistance Choosing to include both positive and negative teaching examples from the outset makes good sense in that it enhances the discriminability of when to produce and when to refrain from producing the communicative act being taught. However, doing so is not without its disadvantages. Including both positive and negative teaching examples may “dilute” the number of teaching opportunities that can be allocated to the positive teaching example. In the short run, this may slow acquisition of the requesting form being taught. There is some evidence to suggest that instruction should begin with positive and negative teaching examples that are maximally discriminable so that it is very clear to the learner whether the request for assistance should be used (Horner & McDonald, 1982; O’Neill & Reichle, 1993). example: When John encounters a peanut butter jar (he loves peanut butter) with a lid that is tightly affixed, he should use his request for assistance. „„Negative example: When John encounters another peanut butter jar with a lid on the container that is not tightly affixed, he should refrain from requesting assistance. „„Positive

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TABLE 6.3.  Response Efficiency and Effectiveness Analysis for a Learner Who Is Taught to Request Assistance Problem behavior

Inefficient/ineffective response

Efficient/effective response

Response effort When John encounters a nonpreferred activity, he quickly begins to tantrum.

John first locates his teacher in the classroom, then locates his communication book, turns to the appropriate page, and then shows it to the teacher.

John touches the symbol for “help” located on a symbol card that is affixed to his desk.

Rate of reinforcement Following John’s tantrum to acquire assistance, his teacher and the classroom assistant approach him a number of times throughout the remainder of the activity to make sure that he is no longer experiencing difficulties.

John has to take between 60 and 90 seconds to locate the teacher, show her the symbol, and receive assistance.

After John tantrums, his teacher not only helps him with the difficult step in the activity but also provides social attention.

After John touches the “help” symbol, his teacher only helps him with the step at hand and offers no positive attention.

When John tantrums, his teacher immediately approaches him to see what difficulty he has encountered.

Following John’s request for assistance, his teacher tells him to wait a few minutes while she finishes working with another student.

As soon as John touches the “help” symbol, his teacher approaches him to provide assistance.

Quality of reinforcement Following John’s request for help, his teacher systematically and consistently offers assistance and reinforces his participation.

Immediacy of reinforcement Following a request for assistance, his teacher immediately approaches him.

Teaching Requesting Assistance 137 Student name:  Sharif

 Observer: L. A.

Activity:  Lunch Time Engaged OR Distance of Item/ Activity Presented Date

Antecedent

(circle one)

Problem Behavior

3/11

Supply box

6 seconds

Tantrum (yells and stomps feet)

3/12

Supply box

3 seconds

Tantrum (yells and stomps feet)

3/13

Supply box

15 seconds

Tantrum (yells and stomps feet)

3/14

Supply box

3 seconds

Tantrum (yells and stomps feet)

3/17

Supply box

3 seconds

Tantrum (yells and stomps feet)

FIGURE 6.3.  Requesting assistance observation form for Sharif.

Across opportunities, teaching examples are made less discriminable, making it less obvious to the learner whether the response should be produced. For example, with John, the presentation of “easy” and “hard” containers was randomized. He was provided with an opportunity to open three or four containers per session. A container was placed in front of him with instruction to go ahead and “open the container.” As soon as John attempted to open a “hard” container, a spoken model “Help, please” was provided. The spoken model was faded using a constant time delay prompt across instructional opportunities. Subsequent to requesting assistance, the interventionist delivered a physical prompt to grasp and twist the “harder to open” lid (in an effort to teach John greater independence). Across successive opportunities, the prompt was systematically faded first by lessening the amount of lid turning done by the interventionist. To do this, the lid and the jar lip were marked in increments with permanent ink so that the interventionist could gauge how much movement was being prompted. Across time, the interventionist released the learner’s hand earlier and earlier.

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An alternative intervention strategy involves initially teaching only positive teaching examples. When the interventionist has been able to fade prompts, instances of negative teaching examples can be incorporated into the activity. The advantage in pursuing this option is that the learner may acquire the request for assistance more quickly. However, the potential downside is that when negative teaching examples are later introduced, some of the learner’s requests that have been reinforced will be placed on extinction. When this occurs, there is an increased likelihood of problem behavior reemerging. There are many reasons why resurgence might occur (St. Peter Pipkin et al., 2010; Sweeney & Shahan, 2013), but one reason we have discussed in previous chapters is the relative response strength of appropriate behavior versus problem behavior. Early on during intervention, problem behavior will likely have more strength because it has a richer history of reinforcement than appropriate behavior. Thus, when a challenge to treatment occurs, such as a negative teaching example, problem behavior may show resurgence because the alternative behavior that has been taught is not reinforced. During intervention, extinction gradually weakens problem behavior (Sweeney & Shahan, 2013) and reinforcement strengthens appropriate behavior. When challenges occur later in intervention, appropriate behavior persists and problem behavior does not resurge (Wacker et al., 2011). We suggest that “challenges” be purposely built into intervention, and that intervention continues until problem behavior fails to show resurgence and adaptive behavior persists. Wacker et al. (2011) worked with young children diagnosed with autism who engaged in severe problem behavior maintained by negative reinforcement. The parents of each child taught the child to request a break rather than to display problem behavior during nonpreferred demands. During intervention, appropriate requests were reinforced with an enriched break and problem behavior resulted in extinction. Very early in intervention, the children learned to appropriately communicate, and most stopped engaging in problem behavior. Periodically, over the course of treatment, extinction probes were conducted, in which all behaviors, including appropriate communication and challenging behaviors, were placed on extinction for 5 minutes. Extinction was, thus, a challenge to treatment. Initially in treatment, problem behavior quickly returned during these extinction challenges (resurgence). However, over time, less and less resurgence occurred, probably because appropriate behavior was strengthened via reinforcement across intervention sessions, while challenging behavior was weakened with extinction. The authors recommended that intervention be continued until challenges to intervention no longer negatively impact the results.

Teaching Requesting Assistance 139

Negative teaching examples, like brief periods of extinction of appropriate communication, are likely to occur for the learner following intervention. If these challenges produce resurgence of problem behavior, then the probability is decreased that intervention will produce long-term maintenance (Nevin & Wacker, 2013). Thus, intervention needs to continue until resurgence does not occur, or occurs at manageable levels, when the intervention is challenged.

Sequences of Intervention As was the case in teaching protesting, there are two possible sequences of intervention that can be followed.

Decelerating Problem Behavior Prior to Teaching Requesting Assistance Some problem behaviors may occur as soon as it becomes apparent to the learner that a difficult or nonpreferred demand is about to be made. This may make it difficult to prompt an assistance request in the absence of problem behavior. If this is the case, it may be impossible for the interventionist to prompt an assistance request prior to the learner’s emission of problem behavior. If problem behavior is followed by a prompt to request assistance, there is some risk that a chain of behavior will be established. To avoid this, the implementation of the following procedure can be useful. Reinforce the Absence of Problem Behavior The interventionist should approach the learner with the difficult task. Prior to the learner engaging in problem behavior, the interventionist should provide the required assistance after the acknowledgment that the learner needed help. Linda approaches Sharif when he encounters his supply box during independent work time and waits less than 3 seconds. She then says, “Oh Sharif, you need help with your supply box, don’t you?” and prompts him to put his hand on the box and then says, “Here you go.” In this case, Sharif was reinforced with avoidance of the task without having to engage in problem behavior. Once problem behavior has been decelerated and Sharif is placing his hand on the box to initiate engagement in the activity, the interventionist can then directly proceed to teaching the learner to produce an assistance request.

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Directly Teaching Requesting Assistance Prompt the Learner to Engage in Requesting Assistance Upon reaching the point in an activity where it is increasingly likely that the individual will require assistance after initiating engagement (but before problem behavior has occurred), prompt a request for assistance. After Sharif has placed his hand on the supply box and attempted to open it (about 1 second, which is less than the up to 3 seconds in the previous example), Linda prompts him to request assistance by touching a “help” symbol. Then, she immediately opens the container so that he can access his writing instruments.

Try to avoid prompting the new response immediately after the emission of problem behavior. This could lead to a chain of behaviors that begins with the problem behavior. If the interventionist is not careful, it is possible that problem behavior will trigger a prompt from the interventionist to use a more socially acceptable form. Although effective in establishing the new form of appropriate communication, it may not result in the desired outcome of decelerating the problem behavior, because problem behavior and the new form of communication are linked or chained together. Introduce Negative Teaching Examples It is important to ensure that there are some opportunities for the learner to independently complete activities or portions of activities in which the learner is competent without requesting assistance. If during a negative teaching example the learner begins to request assistance, the interventionist should interrupt the request before it is completed and redirect the learner to the activity. During negative teaching opportunities, the supply box has already been opened when Sharif begins independent work, or the supply box lid is not tightly affixed. During these opportunities, he can proceed independently.

Fade Instructional Prompts That Are Required to Produce a Request for Assistance When problem behavior has decreased, the interventionist can begin to systematically reduce the level of response prompt delivered. Begin releasing the learner’s hand or arm increasingly earlier across successive successful teaching opportunities. Alternatively, the interventionist could begin to implement a delay between the presentation of the task and the delivery of a prompt to request assistance. This delay can be increased systematically

Teaching Requesting Assistance 141

across successive successful teaching opportunities until the learner is requesting assistance independently. When Sharif is using his “help” symbol to request assistance, Linda (the interventionist) can briefly delay her prompt to the symbol. If Sharif remains successful using his symbol, the delay can be increased slightly across successive instructional opportunities.

Remember that during a negative teaching example, if a learner begins to use an assistance request, it is important to interrupt him or her and instead prompt direct engagement in the activity. If a prompt is required during a negative teaching opportunity across successive opportunities, gradually fade the level of prompt required for the learner to directly engage in the activity. Chapter 4 describes a strategy to initially lessen task demands to allow the release from tasks maintained by escape contingent on desired engagement rather than the interventionist struggling with reacting to problem behavior. When problem behavior has been reduced, the interventionist can gradually increase demands for more independent engagement (see Chapter 4 for a discussion of this as a component of a signaled delay procedure [TFD]). Make Teaching Examples Less Discriminable Across successful opportunities, the positive and negative teaching examples should be made less discriminable, making it more difficult for the learner to determine when a request for assistance is appropriate. As Sharif begins to be increasingly successful using requests for assistance, the supply box lid will systematically be loosened during positive examples, calling for a request for assistance. During negative teaching opportunities, Linda will begin to have the supply box partly opened. Systematically across teaching opportunities, the container will be increasingly more difficult to open.

Instructional Procedures to Reduce Reliance on Requests for Assistance Encouraging More Conditional Use of Requests for Assistance As the learner becomes more independent in using assistance requests, he or she should be learning to more independently perform the difficult component of the activity that has been associated with requests for assistance. This is because each time the learner produces an assistance request, the interventionist provides the level of prompting required to begin to teach the learner to more independently complete the step of the activity that

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precipitated the assistance request. Across successive successful teaching opportunities, these prompts are systematically faded. Often, we choose a most-to-least prompt hierarchy because during the earliest phases of intervention, it increases the probability of prompting and reinforcing a desired response prior to the emission of problem behavior. Of course, if a learner has a history of engaging in problem behavior when someone touches him or her to deliver a prompt, a least-to-most intrusive prompt hierarchy may be more fruitful (see Chapter 4 for more information about these topics). When Sharif is using his “help” symbol to request assistance, Linda can use hand-over-hand prompting to help Sharif complete the next step. As Sharif experiences success with hand-over-hand prompting, Linda can fade back the prompts to partial prompting and then verbal prompting.

Making Independent Task Engagement More Attractive Than Requests for Assistance When the Learner Can Competently Engage in the Activity Once the learner has benefited from positive and negative teaching examples to establish the conditional use of an assistance request, it may be necessary to create a condition in which it is more attractive to act independently than to use a request for assistance. For example, with Timothy discussed earlier, it was necessary to establish a potent reinforcer that was delivered contingent on independent work. If a learner could not independently complete a step of an activity and requested assistance, no social reinforcement would be delivered—­ however, if the learner engaged independently, a powerful reinforcer could be made available. Thus, the incentive for independent work needs to be greater than for requesting assistance (when requesting assistance had been established and subsequently the learner has been taught to independently complete the activity as a result of the prompts and response prompt fading that was delivered). When Sharif experiences success with the task, Linda can provide a reinforcer that is very powerful. The reinforcer should be selected based on a reinforcer preference assessment.

How Will You Know If the Program Is Working? To determine whether the request for assistance intervention is successful, it is important to monitor the learner’s performance. The requesting assistance progress form may be used to document learner progress.

Teaching Requesting Assistance 143

Sharif’s educational team decided that the most efficient means for him to request assistance would be to point to a line-drawn symbol for “help.” Gestural prompts were found to be the most successful. Therefore, he was prompted to point to his “help” symbol just as he was about to open his supply box on the first 6 days of intervention. Teacher prompts were then faded by delaying the time between encountering the supply box and the prompt. Next (not shown on progress form), prompts were given to encourage Sharif to attempt to open the supply box before requesting, as sometimes assistance was not necessary.

Figure 6.4 provides progress information regarding Sharif’s performance for the first 13 days of intervention. He went from requiring a full Student name:  Sharif

  Prompting method:  Gestural

Activity:  Lunch Level of Prompt OR Time of Prompt Delivery Date

Antecedent

(circle one)

Problem Behavior

1/20

Supply box

Immediate

      

1/21

Supply box

Immediate

      

1/22

Supply box

Immediate

      

1/25

Supply box

Immediate

      

1/26

Supply box

Immediate

      

1/27

Supply box

Immediate

      

1/28

Supply box

Delay 3 seconds

      

1/29

Supply box

Delay 3 seconds

      

2/1

Supply box

Delay 3 seconds

      

2/2

Supply box

Delay 3 seconds

      

2/3

Supply box

Delay 3 seconds

      

2/4

Supply box

Delay 3 seconds

      

2/5

Supply box

Delay 5 seconds

      

FIGURE 6.4.  Requesting assistance progress form for Sharif.

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gestural prompt immediately upon encountering a supply box to independently requesting assistance while the interventionist delayed prompt delivery. He did not engage in problem behavior on any of the opportunities. Had recording on the progress form been continued, we would see that Sharif was eventually given assistance only after he had first tried to open the supply box. In this way, negative teaching examples were introduced, as on some occasions a request for assistance was not necessary. On a progress form, the interventionist should keep track of the following data: „„The

learner’s name, the activity, and the observer’s name. prompting method used (physical, gestural, etc.). „„The prompt-­ fading strategy implemented (decreasing magnitude, time delay). „„The date of each opportunity. „„The antecedent for each opportunity to emit a request assistance response. „„The appropriate fading method used is circled and the level of prompt (full, partial, etc.) or the time of prompt delivery (immediate, 3-second delay, etc.) is recorded for each opportunity. „„The last column is used to record (mark with an “X”) problem behavior if it occurs during an opportunity. „„The

In addition, progress can be tracked by examining the visual display of the data in a graphed format; it is also helpful to look at progress data regarding the level of engagement in a particular task. In Sharif’s case, since he was prompted to request assistance, we can assume that he was not required to be actively engaged in attempting to open the supply box. However, when the interventionist introduced negative teaching examples, Sharif was required to attempt to open the supply box prior to requesting assistance (see Figure 6.5).

What If the Learner Starts Requesting Assistance Earlier and Earlier in the Activity? If requesting assistance has proven to be efficient, it is likely that the learner may begin to use the response increasingly earlier or in components of the activity that he or she can competently perform. If this occurs, it is important to refrain from delivering assistance when it is not actually needed. One strategy might be prespecifying a level of performance that must be accomplished prior to requesting assistance.

Teaching Requesting Assistance

145

Percentage of correct responses and occurrences of challenging behavior

Baseline Immediate 3-second 5-second 7-second Negative teaching examples prompt prompt prompt 100 90

Problem

80 70 60 50 40 Task engagement

30

Requesting 20 assistance 10 0

1 Prompt

2

3 Delay

4

5 Delay

6

7 Delay

8

9

10

11

12

13

14

15

Introduced

FIGURE 6.5. Graphed data for Sharif, including correct responses and problem behavior.

Scott requires help squeezing the toothpaste onto the toothbrush. His mother teaches him to touch a graphic symbol whenever he encounters this step in his morning routine. Soon, Scott begins requesting assistance when he begins the toothbrushing routine. His mother set up a graphic schedule for him and told Scott that he could request assistance only on the step with the smiley face on the schedule. If he requested help at any other time, when he was capable of performing the task independently, he would not receive any help.

As discussed in Chapter 4 and mentioned earlier in this chapter, another method is to signal when communication will be reinforced, and then gradually extend the task requirements via demand fading. For example, Wacker et al. (2011) required some of the participants to put blocks in a container. Initially, they needed to pick up only one block, and then two, four, and eight blocks. The participants could request a break once they had completed the required amount of work. This was signaled by a card that said “play” or represented play. Thus, in a two-step chain, the participants needed to first complete their work, and then they could ask to play.

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What If the Learner Continues to Request Assistance Even though He or She Has Learned to Complete Difficult Activities Independently? Some persons become increasingly more independent in performing the task for which they originally needed assistance. Consequently, the learner is expected to rely increasingly less often on a request for assistance. Sometimes, using requests for assistance continue to occur increasingly more often, even though the learner appears to be becoming more competent. It should be possible to arrange the value of a reinforcer to make it more efficient for the learner to engage independently than to request assistance. Initially, Sara was not able to put on her clothing independently. As a result, she began to yell each time she encountered a difficult aspect of dressing (e.g., pulling on her pants, putting on her socks). The interventionist decided that she would be taught to request assistance (i.e., sign, “Help, please”). Over time, Sara became proficient at the dressing task but continued to request assistance because she enjoyed the attention of her teacher and parents. Her teacher and parents decided to alter the available contingencies to make independent engagement in the activity more attractive than requesting the assistance. At the beginning of a dressing activity, the interventionist told Sara that if she independently put on her socks, they would take a break and read a story together. On the other hand, if she requested assistance, help would be given but they would continue with the dressing activity and proceed to the next item of clothing with the reinforcer being delivered after dressing. Additionally, the reinforcer would not be as “good” as a reinforcer delivered for independent work.

Figure 6.6 shows Sara’s progress in learning to dress independently. During baseline, she produced frequent episodes of problem behavior to avoid getting dressed. After she was taught to request assistance, her problem behavior decreased dramatically. During the third phase of intervention, the interventionist gradually began to fade the magnitude of the response prompt delivered after a successful request for assistance. As shown in Figure 6.6, even though Sara was becoming more independent, she was continuing to use requests for assistance on almost every opportunity. In the last phase of intervention, reading a book as reinforcement for independent dressing was made available. Subsequently, Sara’s requests for assistance diminished and independent dressing dramatically increased. Note that generalization probes conducted throughout Sara’s day suggested that requests for assistance continued to be a probable response whenever she encountered a difficult activity that she could not complete independently (see Figure 6.7). In a cumulative graph, the line advances one mark

Teaching Requesting Assistance

Percentage of correct responses and occurrences of challenging behavior

Baseline 100

147

Request Decreasing magnitude assitance intervention of prompt

Differential reinforcement

90 80

Problem behavior

70 60 50 40 30 20

Independent dressing

Requesting assistance

10 0

1

2

3

4

5 6 7 8 9 10 Blocks of five opportunities

11

12

13

14

15

FIGURE 6.6. Teaching requests for assistance in dressing.

Baseline

45

Cumulative instances of requesting assistance

40

Request assistance Decreasing magnitude program of prompt implementation

Conditional use

35 30 25 20

Requesting assistance

15 10 5 0 0

5

10 15 20 25 30 35 40 45 50 55 60 65 Cumulative opportunities to request assistance in novel activities

70

75

FIGURE 6.7. Requests for assistance in difficult activities/generalization probes.

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on both the ordinate and abscissa whenever a correct response is made. If an incorrect or no response is made during the five opportunities, the line will remain at the same level but advance one space on the ordinate and abscissa. These data further suggest that requests for assistance persisted in novel situations, a requirement that should be considered in every behavior intervention plan.

Summary In this chapter, we have described procedural options to teach a request for assistance as an alternative to problem behavior. We have proposed that assistance requests can be implemented to replace problem behavior that is maintained by gaining or maintaining access to desired objects/activities. Additionally, it may also be useful as an alternative to problem behavior that is maintained by escape from cognitively or physically difficult tasks. In describing what we currently know about teaching assistance requests, we suggested that it cannot be assumed that teaching the request to replace one function of behavior will generalize to another function. We proposed that general case instruction seems particularly applicable to teaching communicative alternatives to problem behavior. In describing applications of the procedure, we suggested carefully attending to functional equivalence in matching communicative alternatives to the social function of problem behavior. This involves an analysis of MOs, as well as reinforcers for problem behavior. Additionally, attending to the relative efficiency of problem behavior and the new communicative alternative to be taught is also very important in achieving an acceptable outcome.

Chapter 7

Requesting a Break

The Range of Situations That Support Requesting a Break Requesting a break can be an important communicative alternative for some learners who engage in problem behavior that is maintained by escape. It is particularly helpful with a learner who can successfully participate in an activity but either becomes habituated or satiated with the activity. In either of these situations, providing a brief respite from the activity may result in the interventionist being able to reengage the learner in the activity. If the interventionist is equipped to provide and monitor breaks, teaching a learner to request a break may not only decrease the learner’s propensity to engage in problem behavior but may also increase cumulative engagement in an activity. Typically, Henry yells obscenities at the beginning of math time, even though he completes several steps of a task prior to engaging in an attempt to escape the activity. If not allowed to leave it, he engages in property destruction that involves throwing objects. His teacher noticed that Henry tends to engage in the activity between 3 and 5 minutes before she has observed Henry’s problem behavior.

Tasks become aversive for different reasons. Although Henry did not prefer the math task, it may not have been aversive from the outset. However, with many learners such as Henry, as it continues and the learner habituates, it may become increasingly aversive. In both the case in which a task is immediately aversive and when the learner habituates, teaching a 149

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break request will provide an alternative to problem behavior in gaining negative reinforcement. If it is possible for the learner to have a brief break, teaching a break request may represent a desirable alternative to problem behavior. Just prior to arriving at the point at which the learner typically disengages from a task represents an opportune time to teach a break request. For example, some activities just go on for too long from the learner’s perspective. In this situation, teaching a learner to request a break may provide an opportunity that keeps a learner’s problem behavior from escalating further and makes it possible for him or her to regain the control required to reengage in the task. In this regard, learning to request a break may enhance the learner’s self-­regulatory skills in that the learner may increase his or her cumulative engagement in an ongoing task before requesting a break. This might be best accomplished by pairing the request for a break with a TFD procedure (see Chapter 4). Opportunities to produce a break request emerge as a highly individualistic response to states of deprivation, habituation, or satiation (Wacker et al., 1990). In the case of all three of these states, there may be a variety of both internal (e.g., not having had a reinforcer such as a candy bar for 2 weeks) and external (e.g., having worked on the same task for several weeks) variables that can influence the point at which the learner wishes to access or escape a particular event. For example, in the case of deprivation, feeling thirsty may prompt a desire to obtain water. On the other hand, an individual may see another person drinking a beer in a frosted glass and be influenced by this external event to want a beer regardless of any internal state of thirst. In this latter case, one might have just exercised and be overheated, which would make a cold drink particularly appealing. The event just described is an example of a MO, that established (in this case) a cold drink as a reinforcer (see Chapter 1). Much the same is true with habituation and satiation. For example, one may not habituate on the first lawn mowing of the season. However, by mid-July, having mowed the lawn weekly for some time, one may begin to divert one’s activity for at least brief periods of time during an afternoon of lawn mowing. Satiating on lawn mowing may also have to do with the heat of the day, the effort involved given the length of the grass, and the availability of other activities that the individual is required to do. Thus, just like deprivation, there are many MOs that can underlie a state of satiation. Unfortunately, an interventionist cannot always be aware of the mix of internal and external events that may influence when a learner might need to use a break request. This is why it is very important to emphasize teaching the independent use of break requests. In the interim, the interventionist may need to be relatively more liberal in dispensing breaks in order

Requesting a Break 151

to catch the learner engaging in desirable behavior at the point of a release to a break. This increases the probability over time of not having to react to problem behavior that has a history of being maintained by task postponement or escape. For example, Reed et al. (2005) showed that the timed delivery of breaks (i.e., brief breaks delivered on a fixed time schedule of reinforcement) could decrease problem behavior maintained by negative reinforcement. Of note is that if the breaks were not delivered too often, compliance continued to occur. Thus, fixed-time or noncontingent delivery of breaks can assist the interventionist by reducing problem behavior while the learner is being taught how to independently request breaks. The challenge is to establish a fixed-time schedule that is sufficient to reduce problem behavior, but is not so dense that it abolishes the learner’s motivation to request breaks (if requesting breaks independently is the goal of the intervention). When and if problem behavior does occur, it is important that the interventionist does not react (if possible) and deliver negative reinforcement. Recall from Chapters 1 and 2 that the goal is to make the new communicative alternative more effective in obtaining the reinforcer than problem behavior that in the past has worked well for the learner. When the interventionist is able to decrease the effectiveness of problem behavior while maximizing the outcome for the new communicative alternative, acquisition is apt to occur more quickly (Wacker, Berg, Asmus, et al., 1998), and the interventionist will not have to rely too heavily on extinction as the reactive strategy if problem behavior is produced. Although extinction is effective and has been combined effectively with FCT (Hagopian et al., 1998; Wacker et al., 1990), it can be difficult to fully implement extinction, especially if it produces bursts in problem behavior that are highly disruptive to others in, for example, a classroom setting. In implementing an intervention to teach requesting a break in which full escape extinction cannot be used in a school program, it may be possible to partially implement it by, for example, positioning the learner’s desk in a corner making escape more effortful but not impossible for the learner. Further, when learners escape, they often seek out a more preferred activity. This can be addressed by removing reinforcing activities from the environment or hindering the learner’s procurement of them. However, the interventionist must make it relatively effortless for the learner to produce a break request approximation that in addition to a break, results in access to a preferred item or activity. Thus, the participant learns that requesting a break is more efficient in obtaining release and for accessing more pleasurable activities during a break than continuing to engage in escape-­ maintained problem behavior. Because a break request can be both more efficient and effective than problem behavior, the learner will be more apt

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to produce a break request than engage in problem behavior under the same MO conditions. The challenges in determining exactly when a learner may wish a break make it particularly important during the early phases of teaching break requests, to select planned situations in which you have been able to identify how much engagement is apt to occur before the learner begins to initiate escape behavior. This will help ensure that you can select an interval or quantity of engagement that can be expected prior to releasing the learner to a break. In our experience, one of the biggest mistakes made during the early phases of intervention involves an interventionist’s expectation for initial engagement that simply lasts too long. Emilio’s teacher, Jack, established a work period of 10 minutes prior to granting Emilio a break. During baseline, interventionists noted that Emilio engaged in escape-­maintained tantrums during 80% of his 10-minute work periods. During all but one of the instances in which a tantrum occurred, it was during the last 3 minutes of the activity. After a discussion with the educational team serving Emilio, everyone agreed that in the activity that was the focus of the intervention, the initial expectation for engagement prior to release to a break would be 7 minutes. Choosing this interval pretty much guaranteed that Emilio would have an opportunity to obtain reinforcement contingent on desirable behavior in almost every work period. It was also agreed that once his performance stabilized at this level, the expectation for engagement would be systematically increased in small increments.

In the preceding example, the interventionist reported, “I’ve seen him be able to engage for 10 minutes, so that’s how long we engage before break.” This interventionist argued that the standard of 10 minutes should not be reduced. In our experience, when teaching a learner to request a break, the initial objective should be to release the learner from an activity after a “reasonable” predetermined amount/length of engagement, provided there has also been an absence of problem behavior. The objective is to “catch the learner being good,” (which is what happens during differential reinforcement of other behavior [DRO]) in which the learner is negatively reinforced with respite contingent on no problem behavior. Thus, the goal is based on the learner’s conservative performance history and not on the best he or she has ever performed. We cannot emphasize enough that the primary objective of teaching a break request is to reinforce desirable behavior (rather than directly reacting to problem behavior that has been maintained by escape). Determining the range of how much engagement (how much time/how many items dealt

Requesting a Break 153

with) the learner typically tolerates prior to an escape attempt represents an extremely important step that must occur prior to actually implementing intervention. In situations in which the amount of engagement is very brief, the interventionist could attempt to gradually increase the amount of time the person spends engaged in the activity before requesting a break (e.g., in Chapter 4 we discussed TFD as a strategy that was useful when combined with an intervention such as a break request). For some individuals, escape-­maintained problem behavior can occur often and immediately after a demand has been presented, or it can occur seemingly randomly based on unknown states of deprivation and satiation (MOs). Remember that if the break is enriched (i.e., contains positive reinforcers such as access to a computer in addition to the negative reinforcement obtained as a result of leaving what has become an aversive task), the motivation to escape the demand can be related to deprivation of the positive reinforcers, as well as satiation with the required task (thus, a functional analysis to confirm the reinforcers that maintain problem behavior is important to conduct prior to intervention). It is also important to ensure that the relationship between requesting a break and receiving a break remains constant over the course of the intervention. We want to minimize the probability that the learner begins using a break request as a request for positive reinforcers outside of the context of a task for which he or she has satiated or habituated. Requesting a “break” when one desires a preferred item or activity is an error (Falcomata et al., 2013) because it may confuse the person receiving the request (e.g., the person may tell the learner to leave the activity rather than to provide the activity) and thus inadvertently punish communication. The occurrence of interacting MOs can make prediction of when the problem behavior will occur to be especially difficult. When we are unable to reliably predict when problem behavior will occur, we most often use demand fading (Wacker et al., 2011, 2013). Demand fading (Lalli, Casey, & Kates, 1995) is the systematic process of slowly increasing the amount of effort required by a demand prior to permitting a break to occur. An example of it was provided by Wacker et al. (2011). Wacker et al. (2011) described an in-home FCT program for young children with autism who displayed problem behavior at home. Following a functional analysis, children who engaged in escape-­maintained problem behavior were given very small amounts of the demand to complete prior to taking a break. For example, if the task was to point to pictures in a book, the child needed to point to only one picture prior to returning to play. This was accomplished by identifying separate play and work areas (usually in the living room) with the work area containing a desk or table. The child was permitted to first play for 5 minutes (during which the investigators

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conducted a preference assessment as described in Chapter 3). A timer was set for 5 minutes and the child was given a card that said “play.” After 5 minutes of play, the timer sounded and the parent showed the child a “work” card and said, “Time to work. Point to one picture and then you can play with [preferred item] again.” The child was immediately assisted to the worktable, and a three-step prompting strategy—­vocal, model, and physical guidance—­was implemented. The child needed to point to only one picture before the “play” card (sometimes attached to a voice-­output microswitch) was presented. The child could request to play vocally, by touching the card, or by pressing the voice-­activated switch to resume playing for another 5 minutes. Thus, as discussed by Wacker et al. (2011), compliance produced the word card, and manding produced an enriched break within a two-step sequence. Gradually across sessions, the amount of work (in this case, the number of pictures touched) increased to desired levels. This case description also provides a good example for the type of intervention packages that we often recommend. The individual components of this plan are provided in Table 7.1. Notice that intervention components involve antecedent activities (components 1, 5, and 8), antecedent stimuli during (components 2, 3, and 6) and just prior to working (component 4), behavior reduction procedures (components 7 and 9), and finally, differential reinforcement of functional communication (component 10). Because there are so many components, these FCT programs must be internally consistent. By internally consistent, we mean that all of the components must be working together. For example, the prompting procedure must promote independent work if independent work leads to breaks. In the example shown in Table 7.1, if problem behavior leads to escape from the task (e.g., a time out rather than an escape extinction component was included in the treatment package), then some of the components provide reinforcement for task completion while others concurrently reinforce problem behavior with the same reinforcer (breaks from the task). When both appropriate and problem behavior produce the same reinforcer, it will be much more difficult for intervention to be effective. Sometimes a problem behavior cannot be stopped and we also cannot prevent at least brief breaks from occurring following problem behavior. For example, a learner may be too quick for us to stop from engaging in aggression, and so we cannot prevent at least brief breaks from the task while the individual is displaying aggression. In other cases, we are working with more than one learner and thus cannot always prevent a learner from discontinuing his or her work. This is why components 1 and 5 (depicted in Table 7.1) are so critical. If we have identified highly preferred stimuli that are used to enrich the break, then we may be able to bias responding toward task completion and communication. It is only through these

Requesting a Break 155 TABLE 7.1.  Individual Intervention Components in Our In-Home FCT Program for Requesting Breaks Component

Description

 1. Initial free play

 1a. Show learner available play material.  1b. Engage in high-quality play.

 2. Timer

 2. An audible kitchen timer or a visual clock.

 3. Play/work cards

 3. Large cards that indicate or show activity.

Function  1a. Preference assessment.  1b. Identify preferred items for enriched breaks.  2. Signals transitions.  3a. Prompt engagement in specific activity  3b. Signals when reinforcement is available (play).

 4. Separate play/work areas

 4. Use tape on furniture to show designated areas.

 4. Establish clear contexts for playing or working.

 5. High-quality attention during play

 5. Play very enthusiastically.

 5. Enrich the break.

 6. Three-step prompting

 6. Provide vocal, model, and physical prompts in a three-step hierarchy.

 6. Guide correct responding and facilitate independent responding.

 7. Escape extinction

 7. Do not remove demand for problem behavior.

 7. Remove negative reinforcement for problem behavior.

 8. Demand fading

 8. Slowly increase demands.

 8. Build up tolerance for tasks and delay to reinforcement.

 9. Response cost

 9. Problem behavior during break results in an immediate return to work.

 9. Punish occurrence of problem behavior during breaks.

10. Mand

10. Learner requests break following completion.

10. Reinforcement provided for appropriate communication.

11. Release cue

11. Learner receives a cue that he or she is almost ready for a break.

11. Signals that reinforcement is very close to being accessed.

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responses that access to the enriched break can occur. Harding, Wacker, Berg, Winborn-­Kemmerer, & Lee (2009) demonstrated that at least some learners will choose enriched breaks over breaks alone, even if that requires that they complete some work. Using demand fading (component 8 of Table 7.1) further increases the probability that the learner will choose to work because the initial requirements of the demand are quite small. After a learner has engaged for the required length of time or reached a quantitative performance criterion (e.g., assembling three widgets), the interventionist can offer a delay signal (e.g., “Almost done,” “Only one more”), and then after that modest remaining amount/duration has been completed in the absence of problem behavior, release the learner to a break (see component 11 of Table 7.1). The “release cue” that we discussed in Chapter 4 during our description of TFD serves an important function in teaching a break request. Many learners who engage in escape-­ maintained behavior release themselves from an activity. In these instances, problem behavior is produced when the learner’s self-­release is impeded. Teaching the learner to follow the directions of a parent, teacher, or supervisor is part of instructional control. Thus, with learners who have a history of escape, it may be important to teach the learner that one waits for a release cue when working during an assigned activity prior to leaving it. This release cue could be a teacher saying, “OK, we are done. Turn in your papers.” In other activities, it could be the learner completing a worksheet, which signals taking it to a classroom paraprofessional to check his or her work. Thus, once the learner independently and appropriately requests a break, a final component is to build in a release cue and to begin developing a TFD (Fisher et al., 2000). Another important aspect of teaching a break request is that one must also learn to use the break request in a way that balances the empowerment that comes in requesting a break with the self-­regulation skills to realize that one must not overuse a break request. To encourage learning when and when not to use a break request, an interventionist can move a delay signal gradually but systematically later into the task (see Chapter 4 for detailed examples and a refresher on delay cues). Across instructional opportunities, the criterion for the quantity or duration of engagement that occurs between the delivery of the delay signal and release from the task can be increased via fading (in this case, delaying the interval of time between the signal and reinforcement). Once a learner has shown increased engagement in accordance with the established expectations (but with low rates of or no problem behavior), the interventionist then creates an opportunity for the learner to request a break. In this option, once a break request has been produced, the learner can be released from the activity (provided of course

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that problem behavior has not occurred). If problem behavior occurs, it should be considered as an error that will need to be addressed with escape extinction. One option, then, is that prior to teaching a break request, the interventionist may choose to enhance the learner’s self-­regulatory skills by teaching longer or greater sustained task engagement prior to teaching a break request. However, for some learners who engage in more rapidly emerging or serious problem behavior, it may be useful to first teach a break request followed by introducing a TFD to help prevent the overuse (overgeneralization) of break requests. In this scenario, once the more serious problem behavior has been diminished and replaced with a break request, the interventionist can then take steps to increase engagement prior to producing a break request. As a third variation on the two options already described, it may be preferable to first teach a break request during activities that have no prior association with escape (Mace et al., 2010). Mace et al. (2010) taught individuals with developmental disabilities an alternative—­however, initially, training was conducted in a context in which problem behavior had not been reinforced. This resulted in less resurgence of problem behavior during subsequent brief periods of extinction (see Chapters 1 and 2 for a discussion of resurgence). In implementing this option, an interventionist may be better able to focus on teaching the new replacement behavior under conditions that are less stressful to both the learner and the interventionist. Further, once a learner is more fluent in the emission of the new communicative behavior, it may be easier to extend its use (i.e., to generalize) in situations when the production (in this case, a break request) must compete with problem behavior. Next, we provide examples of implementing each of the options that we have described that extend or alter the procedures shown in Table 7.1. Subsequently, we follow these examples with detailed procedural descriptions of each strategy. Increasing engagement prior to implementing a request for a break

During each of three successive morning circle times, Amy typically participates for about 3–5 minutes prior to attempting to escape. Her interventionist chose a 3-minute period of engagement to reinforce with a break during the initial stage of intervention. Her interventionist selected 3 minutes to ensure that Amy would be successful during 100% of the instructional opportunities. During the initial intervention, her teacher set a timer for 3 minutes. After that engagement, and as soon as the timer sounded, her teacher released Amy from morning circle. After obtaining a drink from the fountain outside her classroom, Amy returned to the circle time activity for another period of engagement.

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Across successive periods, her teacher systematically increased the length of Amy’s engagement in the activity prior to providing her with another break period. Her teacher selected a small pager that Amy wore. Amy quickly learned that when the vibrator activated, she had reached a break opportunity. Across successive successful engagements with no problem behavior, the criterion for engagement prior to release increased systematically. Once Amy’s engagement without problem behavior reached 5 minutes, her teacher began teaching Amy to request a break at the end of a 5-minute period. The “release cue” and SD provided by the pager vibration signaled Amy that a break request would be granted. In Amy’s case, her break request involved raising her hand, which required a partial physical prompt of taking Amy’s hand and raising it, and then releasing her hand before it was fully extended. Across successive successful teaching opportunities, the teacher systematically decreased the magnitude of the response prompt by letting go of Amy’s hand earlier and earlier. To further assist in the fading of the prompt, the interventionist also implemented a time delay in which she waited 5 seconds prior to initiating the physical prompt. Recall that in our discussion of Table 7.1, we emphasized the importance of all components of the intervention package being internally consistent. A time delay prompt system involves slowly increasing the amount of time the interventionist waits before prompting the required response. In this case, the prompt is physical guidance and the required response is raising Amy’s hand. Increasing the delay to providing the prompt also delays the learner’s access to reinforcement. This delay likely increases the learner’s motivation to emit the required response in order to more quickly access reinforcement. Thus, after showing the learner how to emit the response with immediate physical guidance, the physical guidance is delayed to provide an opportunity for the learner to independently emit the response. This is internally consistent with a negative reinforcement program. If, however, the learner was reinforced by physical contact from the interventionist, this would not be an internally consistent program, as this type of prompting would reinforce waiting for the interventionist to provide physical guidance. Eventually, Amy learned to raise her hand independently.

In Amy’s case, once problem behavior had diminished, the interventionist could teach her to better self-­regulate her behavior by adding TFD to the intervention package. In our next example, a learner was taught a break request followed by TFD to increase task engagement. Teaching a request for a break followed by procedures to increase task engagement

A functional assessment implemented with Jamari, a teenager with autism spectrum disorder and a moderate intellectual delay, revealed that he

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attempted to escape from a number of academic tasks. His educators had a difficult time accepting that escape was the function of his problem behavior. They observed that Jamari often chose to do simple math problems as a free-time activity. School staff reported that, at the beginning of the year, he participated in math for up to 10 minutes. However, after briefly engaging, typically, he attempted to abandon the activity. Often, staff members responded to escape attempts by repeatedly bringing Jamari back to the activity and implementing a response cost procedure. Each time he got out of his chair, he lost points (which could be traded for a variety of edible treats periodically during the day). As the school year progressed, educators reported that Jamari’s escape attempts began to occur increasingly earlier in the task. By mid-­October, they had become convinced that his problem behavior was maintained by escape. By the beginning of November, Jamari had become so aggressive that staff allowed him to leave the area at the first sign of combative behavior. Consequently, his participation in academic activities became increasingly less frequent. But, perhaps even more problematic, was that Jamari had learned that aggression or the threat of aggression resulted in immediate breaks from work and thus was an effective communicative tool. Jamari’s teacher decided to provide a socially acceptable strategy to avoid academic activities. As soon as an approaching educator said, “It’s time for math,” staff provided a model for him to touch a graphic symbol that was taped to the upper left corner of his desk. A model was chosen because Jamari had a history of readily following a modeled prompt. On the first day that the prompt was implemented, Jamari touched the symbol. Immediately, his teacher said, “OK, no problem,” and removed the work from his desk. Jamari was allowed to get other material and return to his desk. Across opportunities, the response prompt was faded systematically via time delay until he was touching the symbol independently. At this point, Jamari’s “request for a break” functioned more like a protest in that he avoided the activity but had to return to the setting. In implementing the program just described, educators viewed the problem behavior as sufficiently dangerous that it had to be decelerated before any other intervention was implemented. The next phase of intervention focused on enhancing Jamari’s self-­regulation skills prior to his release to a break. Once Jamari was proficient at independently requesting breaks, his teacher initiated a program that provided a choice. He could sit where he was and do nothing during a break for 1 minute, or he could complete math problems for a brief period and then gain 5 minutes of free time with a number of highly reinforcing activities during an enriched break. Jamari chose the math problems. When the problems were complete, he could request his break. Prior to initiating math, his teacher reminded him that he could request a break as soon as he had completed the work.

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After completing a math problem, his teacher was prepared to prompt Jamari to request a break—­however, he requested a break independently. Subsequently, the amount of work required in order to access the highly preferred break activities was systematically increased, from, for example, one problem to two problems to five problems and so forth.

In Jamari’s case, he was first taught to request a break, and then, subsequently, an effort was made to increase task engagement. Selecting this program option for Jamari resulted in a rapid deceleration of problem behavior. This allowed him to more easily continue to be served in an inclusive educational setting. A third intervention option involves teaching a communicative alternative in a situation that has never been associated with problem behavior to gain escape. Teaching a communicative alternative in a context that has not been associated with problem behavior

Tia was a middle schooler with a severe intellectual delay. We worked with Tia’s staff to teach a break request. Originally, when we interviewed Tia’s staff members as part of a functional behavior assessment, they had told us that there were some situations in which Tia requested a break by producing the sign “break.” In each of the instances that a staff member related, Tia had finished a task that was not aversive (e.g., drawing a picture); she showed the staff member the picture and then asked for a break. After showing her picture, she returned to the activity and continued. Tia’s break requests in situations such as the one just described somewhat resembled a “request for a work check” in which the learner is essentially asking, “Did I do well enough to be positively reinforced?” It is likely that during the task, the attention from an educator became more reinforcing than engaging in the art activity. After Tia had gained attention, she was ready to return to the art activity. In Tia’s case, she clearly did not find the drawing task aversive. In virtually every instance that educators could remember, she returned to continue art with no or very little prompting. In reviewing Tia’s functional behavioral assessment results, we decided that we could strengthen the fluency with which she produced the break sign and then begin to prompt it during tasks that were associated with problem behavior maintained by escape. Our logic was that with a well-­established form of communication, we should be able to more quickly fade any prompts that were required to obtain the use of the behavior in these newly identified situations. And, as discussed by Mace et al. (2010), this approach permitted us to avoid reinforcing responses that were correlated with problem behavior in the context in which problem behavior had previously occurred.

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Regardless of which of the options we described is chosen to establish a request for a break, we have found that two challenges often arise: (1) the learner does not want to terminate the break and return to work, and (2) the learner begins to request a break earlier in the activity.

Ensuring Return from a Break If one views the work from which one wants to leave as aversive and a break as reinforcing, the obvious question is why a learner would want to leave the break to return to work. Unless the learner satiates during break, there is little plausible reason for him or her to be motivated to return to work. To maximize the efficiency for the learner of using a socially appropriate break request, the learner is provided with a combination of negative reinforcement (leaving the task) and positive reinforcement (engaging in a desired activity during the break). Additionally, this enriched break has social validity (it is what most people do when they take a break). Because this is the manner in which we often go about teaching break requests, it is important that we describe each of several strategies that may be needed to increase the propensity for the learner to be willing to return to “work” from a break activity. Of course, some learners follow the play–work–play schedule, and so consistent use of structured routines, clear visual schedules, and consistent use of the intervention components are often sufficient. For those learners where it is not sufficient, we often implement one of the following procedures.

Positive Reinforcement for Extricating from a Break We have found that it can be helpful to have a highly preferred item available that can be delivered contingent on a learner’s successful return to work. The availability of a potent reinforcer makes it easier to motivate the learner to leave a break item activity, which may be under at least mild satiation. In some cases, the reinforcer is a tangible that has been consumed by the time the learner has returned to the task. In other situations, the learner has taken a small toy from break back to the task. The toy is allowed to stay at the corner of the desk, as long as the learner engages in the task and the toy does not distract him or her from task engagement. In our telehealth project, in which we implement FCT directly in the homes of young children with autism (Lindgren et al., 2016), we often place a clear visual cue on the worktable to put the item on. We call this a “safety spot” and ensure the learner that no one will touch the item while it is on this spot. This is often sufficient for the child to return to work. In home settings, siblings, pets, and others may take an item while the child is working.

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The safety spot prevents this from occurring, and can be correlated with an increased willingness to work. In some instances, we increase the opportunities to extricate from a break; we reinforce the learner during break for allowing an interruption in the break activity. Initially, this is just stopping for a second, and then for increasingly greater periods of time (i.e., fading). We do this to teach the learner to tolerate delays during his or her breaks. We combine this approach with teaching the learner to bring a preferred activity to show the interventionist prior to returning to break. This again increases TFD opportunities. For other learners, to facilitate their disengagement from a pleasurable activity encountered during break, we use the safety spot described above, which constitutes a parking space on their desk for an item that they bring with them from break. The item is set next to the learner’s work area. While the learner reengages in work, the toy is placed on the safety spot where no one else is allowed to touch it. Across successful opportunities, we then extend this program with the goal being to find a safety spot that is separated from the work area (e.g., the spot is in a locker or cubby). We can then prompt a break request (following the successful delivery of a delay signal and release cue) to return with the toy to break time. Across successful opportunities, the length of work engagement can be increased systematically, as can the distance of the safety spot from the work task.

Delayed Reinforcement of Successful Break Extrication When a break has been completed, the learner quickly returns to a work activity in a timely manner, and reengages in the task with no problem behavior, we can intermittently deliver the next release cue earlier than it was scheduled to occur. In essence, this strategy provides the interventionist with opportunities to reinforce the learner for timely termination of his or her break. From the learner’s standpoint, this means that sometimes he or she receives another break shortly after returning to work if he or she refrains from engaging in problem behavior or procrastinating. The logic behind this option is that being good “pays off” and one is never quite sure when this consequence will occur for desired behavior. Stokes and Baer (1977) referred to this as using “indiscriminable contingencies.” In our experience, it is important that this option is not one that is delivered each time the learner appropriately leaves a break to return to work, but instead is delivered intermittently. The lack of predictability can cause some initial confusion for the learner, but later can lead to greater flexibility when unexpected changes to the routine occur. For example, the strategy of occasionally allowing a quick return to and from a break may increase the motivation of the learner to return to work in a timely and socially appropriate manner.

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Ensuring a Sufficiently Brief Engagement in the Nonpreferred Activity as the Result of an Accurate and Valid Baseline As mentioned earlier, educators often set expectations for engagement at the same level for all learners across all tasks/activities. However, for learners whose problem behavior is reinforced by leaving the activity, it is often necessary to vary such expectations, beginning with lower expectations for engagement. We then gradually increase these expectations as the learner tolerates longer and more frequent engagement, and shorter and less frequent breaks. In this respect, the amount of engagement that a learner will tolerate prior to engaging in problem behavior is apt to differ across activities. Consequently, the examples of the procedures that have been discussed must be customized for each activity in which the communicative alternative is to be implemented, and speaks to the importance of linking the results of a well-­executed functional behavior assessment to intervention planning.

Reinforcing Return to Work with a Slower Resumption of Work (Easing Back into Work) Once a learner has returned to an activity from which he or she has taken a break, an interventionist might decide to allow the learner to ease back into the work activity. Many of us pour coffee and drink it or check our e-mail prior to diving into a work task. For some learners, we should consider avoiding the temptation to immediately begin prompting and directing engagement in order to provide the learner with an opportunity to “ease back” into engagement. In some respects, one might think of this as breaking down the task into two steps: (1) returning to the work setting, and then (2) engaging in work. Reinforcement may be needed, at least initially, for each step. It may also provide an opportunity to remind learners that they control how quickly they can return to their next break. One example for how we do this is to have a series of high-­probability tasks (e.g., Davis & Reichle, 1996; Houlihan, Jacobson, & Brandon, 1994; Killu, Sainato, Davis, Ospelt, & Paul, 1998) that we prompt prior to starting work. For example, with our young children with autism, we “require” them to give mom a high-five, allow mom to tickle them, and one or two other “tasks” they enjoy. Implementing this procedure serves two purposes. First, if these activities are highly preferred, their engagement may reinforce coming back to the work area from a break. To increase this possibility, make sure to assess the activities within a preference assessment as described in Chapter 3, and restrict these activities to times when learners have completed work. Second, these activities are associated with other less preferred requests from mom, and we hope that they reduce the child’s motivation to escape

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the work situation. By pairing these types of preferred tasks with less preferred tasks, we hope to abolish escape as a reinforcer (i.e., abolishing operation).

Ensuring Moderation in the Use of Requests for a Break Once learners become more fluent in producing a newly acquired break request, they may test the request’s limits by producing the break request at earlier points in the task than had been associated with escape. Although, typically, interventionists think of generalization as a desirable outcome, this could be viewed as a type of overgeneralization (overuse or undesirable generalization). This is a problem that must be addressed quickly and systematically. There are a variety of potential strategies we use to help minimize this challenge.

Competing Schedules of Reinforcement As discussed previously, to avoid the overgeneralized use of break requests, a competing schedule of reinforcement can be implemented. For example, if Jamari prematurely requested a break, he might gain a 1-minute release from the activity with no reinforcing activity offered during break time. However, if he waited to request a break until he had completed a specified amount of work, he would receive 5 minutes with his favorite computer game. Peck et al. (1996) showed that children will often choose the option that provided the highest quality and quantity of reinforcement. Once again, having an enriched break is key for this approach to be successful.

Tolerance for Delay in the Delivery of Reinforcement In other instances, when a learner prematurely requests a break, the interventionist may choose to implement TFD as a consequence for the premature request. In this option, a delay cue would follow the learner’s request specifying the amount of work that remains to be completed. This strategy is apt to be much more effective if the interventionist has implemented it prior to teaching the use of break requests. Remember that in Amy’s case, the vibrating pager signaled when release from the activity would be granted. Using this strategy communicates to the learner that if he or she requests prematurely, he or she will receive a tolerance cue that, in effect, directs the learner to complete the amount (or duration) of work remaining. Because competing schedules of reinforcement and TFD represent common strategies to support the implementation of communicative alternatives to less socially acceptable behavior, we discuss each strategy

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individually. In the sections that follow, we examine each of the components of the instructional procedure that we have just overviewed.

Competing Schedules of Reinforcement A competing schedule of reinforcement offers a highly preferred item (reinforcer) for an enhanced effort concurrently with the offer of a less preferred reinforcer for a smaller effort. The notion of competing responses in establishing an alternative response to problem behavior is well established in the literature (Mace & Roberts, 1993; Neef et al., 1992; Neef, Shade, & Miller, 1994). With respect to communicative behavior, the use of competing schedules of reinforcement has been reported as successfully establishing communicative alternatives to problem behavior (e.g., Horner & Day, 1991; Peck et al., 1996). Vollmer et al. (1999) demonstrated that learners could discriminate between reinforcers of larger and smaller values and would engage in larger quantities of work to obtain the larger reinforcer. This demonstration is relevant to issues of self-­control (i.e., the choice of a larger but delayed reinforcer) and impulsivity (i.e., the choice of a small immediate reinforcer). This investigation involved two young boys who engaged in aggression that was maintained by access to food and preferred activities. Problem behavior was maintained on one schedule of reinforcement, while an appropriate communicative alternative was maintained on another reinforcement schedule. These investigators hypothesized that the learners would allocate responses to the option that was associated with the most attractive reinforcement option. Additionally, they proposed that immediacy in obtaining reinforcers might reflect the strength of impulsivity over self-­control. In one condition, these investigators examined the differences resulting from the use of a delay cue. In both the delay signal and no delay signal conditions, the communicative response produced a larger reinforcer (e.g., three chips, 60 seconds of TV) after a 10-second delay, while aggression produced a smaller immediate reinforcer (e.g., one chip, 30 seconds of TV). For one learner, the delay signal involved the interventionist putting her hand on the chip bag (delay cue) after the learner produced the request and leaving it there until the 10-second delay had transpired. For the second learner, the interventionist set a timer (delay cue) and placed it in view of the learner when he requested an item. During the no delay cue condition, both participants engaged in aggression during a large percentage of the opportunities. Alternatively, when the delay to the larger reinforcer was signaled, both learners produced substantially less aggression. Concurrently, participants increased their use of appropriate requests for the larger delayed reinforcer. This study and others (e.g., Peck et al., 1996) provided

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additional evidence that for learners who engage in problem behavior, reinforcement conditions can be altered for problem behavior and a desired communicative response with the learner allocating more responding to the socially communicative alternative over the problem behavior.

A Brief Review of TFD as a Component of Teaching Break Requests A detailed discussion of TFD was provided in Chapter 4, and we have made frequent reference to this procedure. Briefly, to successfully compete with challenging behavior, it may be necessary that requesting a break must be reinforced immediately. Over time, the objective is that the reinforcement for using a request for a break can be delayed without the learner reverting to his or her previously used problem behavior. Usually, a systematic strategy must be implemented to teach the learner to tolerate a delay prior to task release. One strategy is to implement a procedure to increase the learner’s TFD. In implementing a TFD, the interventionist delivers a delay cue and subsequently, a release cue (safety signal). The communicative mode used by the interventionist to express the delay cue may be vocal (e.g., “Hang on,” “Just a second,” “One more”), gestural (e.g., holding up an index finger), or graphic (e.g., a “wait” symbol), and is presented before the learner engages in problem behavior. The delay cue informs the learner that escape from the activity or access to attention or other preferred items will be delivered soon, and contingent, on the learner’s continued appropriate behavior. Delay cues differ in the degree to which they provide the learner with an opportunity to monitor the approach of reinforcement. An explicit delay cue specifies the criterion for reinforcement. Robert is a young boy who throws materials to escape activities during a block-­building activity. His teacher chose to deliver an explicit delay cue. Just prior to the point at which the learner is apt to disengage, the teacher may say, “Do one more.”

The teacher could have implemented a general delay cue that simply informs the learner that reinforcement will be delayed, but conveys little information regarding the criterion for the onset of reinforcement (e.g., “Almost done”). Both options are effective and we use both across learners in our intervention programs. Also as discussed in Chapter 4, delay cues may vary in their permanence—­that is, some delay cues are transient and only briefly signal the delay interval (e.g., a verbal delay cue). Alternately, a delay cue can last

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the duration of the delay to reinforcement and signal the entire and diminishing delay interval (e.g., setting a timer). After a brief period of socially acceptable behavior following the delivery of a delay cue, Robert’s teacher delivered a release cue to mark the onset of reinforcement. His teacher chose a spoken utterance (e.g., “OK, we’re done,” “Here you go”). However, she could have instead chosen a visual event (e.g., removal of task-­related materials), or an auditory event (e.g., a timer rings).

Mowrer (1960) described a “safety signal” as any stimulus that reliably signals “that the noxious stimulus will soon end” (p. 129). Carr and his colleagues (Carr & Newsom, 1985; Carr, Newsom, & Binkoff, 1976, 1980) later demonstrated that delivery of a safety signal was related functionally to decreases in escape-­motivated challenging behavior among individuals with severe developmental disabilities. Because the term safety signal was used in the animal literature, a more contemporary term that has been used is release cue. Regardless of the choice of term, this signal functions as a conditioned reinforcer. The learner requests reinforcement (e.g., a break), the teacher says something general (e.g., “In a minute”), says something specific (e.g., “One more problem”), or gestures (e.g., holds up an index finger) that the break is about to occur. The presence of this conditioned reinforcer temporarily abolishes the learner’s motivation to escape.

Investigations That Successfully Implemented TFD Combined with a Communicative Alternative for Problem Behavior Reichle and colleagues (Sigafoos, Doss, & Reichle, 1989; Sigafoos & Reichle, 1991) described “safety signal conditioning” (release cue) procedures that incorporated a release cue (safety signal) as a component in decelerating escape-­ motivated problem behavior. Sigafoos and Reichle (1991) described a delay signal as an external stimulus that correlates with the end of an activity. These investigators implemented a TFD intervention with a learner whose task engagement was qualitatively acceptable, but was limited in terms of duration. These investigators introduced a delay signal (e.g., “Just a second, almost break time”) just prior to the point in the task when problem behavior was likely to occur. Eventually, prompting the learner to produce a break symbol occurred immediately after the delay signal. Subsequently, the interval between the delay signal and the opportunity to request a break was eventually increased through a fading procedure (slowly and systematically increasing the delay interval). Carr and his colleagues implemented a TFD strategy with four individuals who produced problem behavior to gain access to preferred items (Carr

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& Carlson, 1993; Carr et al., 1999), four persons who engaged in escape-­ motivated problem behavior (Carr et al., 1999; Kemp & Carr, 1995), and one individual who produced attention-­maintained problem behavior (Carr et al., 1999). The methods employed in these studies generally followed procedures described in Carr et al. (1994). Kemp and Carr (1995) utilized a similar approach with learners with developmental disabilities who were employed at a greenhouse. First, each participant learned to request a break or to request assistance. The variables that reliably predicted production of problem behavior differed for each of the learners (e.g., task duration, negative feedback for mistakes), but were identified through a functional analysis. Once the learners produced requests independently, interventionists implemented a TFD procedure. For example, when the learner produced a request for a “break,” the interventionist provided a spoken delay cue (e.g., “Sure, you can have a break as soon as you water the soil”). Release occurred contingent on task completion. Subsequently, interventionists added a second planting step for two of the learners. This intervention resulted in an increase in time spent gardening and a decrease in competing escape behavior. Lalli et al. (1995) implemented a slightly different variation of TFD. Three individuals with intellectual disability participated. Interventionists taught each individual to engage in a task that was associated with escape-­maintained problem behavior. Initially, the experimenter told the participant that when he didn’t want to work to say, “No” (or another equivalent vocal response). Noncompliance resulted in the interventionist providing a model of “no.” Contingent on a correct production of “no,” the interventionist offered praise and a 30-second release from the task. Systematically, the number of steps to be completed to access reinforcement was increased from one to 16. Procedurally, the interventionist delivered an instruction to the participant, stated the criterion for earning a break (spoken delay cue), and pointed to the materials related to the specified criterion (spoken delay cue). When the learner produced the spoken response, the interventionist said, “Good saying ‘No,’ but you have to do [task step], and then you can ask for a break.” Noncompliance resulted in the interventionist physically guiding the participant to engage in the task-­related response. Using this procedure, each of the participants learned to complete a 16-step instructional task successfully prior to requesting a break. Hagopian et al. (1998) reported results for a series of 24 single-­case analyses. For some participants, demand fading (gradually increasing the amount of work or duration of participation prior to release from an activity) was implemented. Producing a communicative response prior to completing the specified demand resulted in the interventionist delivering a

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general delay cue (e.g., “That’s nice asking, but you need to do some more work”). With other participants who engaged in problem behavior maintained by attention or a preferred item, delay to reinforcement was applied after a functional communicative behavior had been taught. For some of the learners, intervention procedures appeared to incorporate most of the components of a TFD procedure. FCT was effective in reducing problem behavior for 21 participants only when interventionists implemented a consequence component (i.e., extinction or punishment) for problem behavior—­that is, FCT with extinction was successful in reducing problem behavior for 11 individuals to 90% below baseline levels. However, once increasing demands resulted in an increased delay to reinforcement, procedures responding to the problem behavior were required to maintain these behavior reductions for six of the participants. As discussed previously (see Table 7.1), there really is no single procedure called FCT. FCT describes a package of components, with the terminal response for reinforcement being a functional communicative response. All other components in the package are based on the learner’s skills and preferences, the training context, and the goals of intervention. In the remainder of this chapter, we describe intervention strategies other than the ones in Table 7.1 that we have successfully implemented to establish requesting a break as an alternative to escape-­maintained problem behavior.

A Sample Guide to Teaching Requesting a Break1 Getting Ready to Teach Requesting a Break Determine the function served by the challenging behavior by implementing a functional behavior assessment that includes a functional analysis, if possible. Identify the critical event (MO) that cues the child to engage in escape-­motivated challenging behavior. 1 The

description of the procedures that follow were adapted from “Communicative Replacement Strategies for Challenging Behaviors That Serve the Function of Avoid/ Escape: Break Requests,” Principal Investigators Joe Reichle, PhD, and Mary McEvoy, PhD, and Co-­Investigator Carol Davis, EdD, University of Minnesota. This project was supported in part by Grant Nos. HO24D40006 and H024P10017 from the U.S. Department of Education to Joe Reichle, PhD, and Mary McEvoy, PhD, at the University of Minnesota. Contributors included Mary Ann Marchel, Laura Moore, Shelley Nielsen, April O’Keefe, Melissa Olive, Amy Richardson, Rebecca Smith, Kathleen Wolff, Robert Utke, Kathryn Drager, Susan Johnston, Kathleen Feeley, Michael Harris, Elisabeth Rogers, Virginia Traylor, Sandy Charron, Amy Hicks Marquez, Gretchen Jackson, Karen Anderson, Judy Bartlett, and Kayleen Vieberg.

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Once you have identified activities in which escape-­maintained problem behavior is produced, you should identify the antecedent trigger associated with problem behavior. In some activities, the length of engagement may serve as the critical event. Each day during reading, Soledad throws materials within the first 4 minutes of the scheduled 15-minute period.

In other activities, the number of repetitions of an activity or number of portions of an activity completed might serve as a critical event. Each day during art activity, Becky quickly colors/paints one or two pictures prior to disengaging from the activity. A tantrum is apt to be produced if she is not quickly released from the activity.

Figure 7.1 illustrates an example of a data recording form used to record either the length of time a child will engage in an activity or the number of discrete tasks the child will complete prior to engaging in challenging behavior.

Student name:  Timmy

 Observer: T. K.

Activity:  Art Time Engaged OR Distance of Item/ Activity Presented Date

Antecedent Event

(circle one)

Problem Behavior

10/15

Coloring/painting

4 minutes, 10 seconds

Throwing materials

10/16

Coloring/painting

4 minutes, 0 seconds

Throwing materials

10/17

Coloring/painting

4 minutes, 15 seconds

Throwing materials

10/18

Coloring/painting

4 minutes, 5 seconds

Throwing materials

10/19

Coloring/painting

4 minutes, 5 seconds

Throwing materials

10/22

Coloring/painting

4 minutes, 15 seconds

Throwing materials

FIGURE 7.1.  Requesting a break baseline observation form.

Requesting a Break 171

The baseline depicted in Figure 7.1 should be implemented during multiple days to determine a range of engagement prior to an escape attempt. Subsequently, the interventionist should identify the smallest amount of time or the minimum number of discrete actions that the learner completes prior to the production of problem behavior.

Identify Specific Activities That Can Serve as Teaching Examples Both positive teaching examples (situations in which a request for a break may be honored) and negative teaching examples (situations in which a child should refrain from engaging in a request for a break) should be identified (see Chapter 3 for a review). Including both positive and negative teaching examples from the outset makes good sense. However, doing so may dilute the number of teaching opportunities that can be allocated to the positive teaching example, which, in turn, may slow acquisition of the requesting form being taught. When including both, begin instruction with positive and negative teaching examples that are maximally discriminable, so that it is very clear to the child whether the request for a break should be used or not. Across opportunities, teaching examples are made less discriminable, making it less obvious to the child whether the response is to be produced.

Determine the Communicative Form and Consider the Efficiency of the Communicative Replacement To ensure that the communicative alternative is efficient from the learner’s perspective, it is important to examine the efficiency of the communicative response in relationship to the existing problem behavior (Horner & Day, 1991). Table 7.2 (similar to tables in Chapters 5 and 6), also provided in Chapter 1, illustrates how one might consider each aspect of response efficiency when teaching a request for a break as a communicative replacement for throwing materials (which serves the function of escaping from tasks).

Reinforce the Absence of Problem Behavior The interventionist should use the time or minimum number of discrete tasks prior to problem behavior identified during the functional assessment in determining when to deliver a break. Require engagement prior to offering a break that is apt to result in success with no problem behavior. As one approaches the point at which a break is to be offered, say, “Do you want to take a break?” To enhance the value of break time, arrange a choice of preferred activities. The enriched break will then provide negative

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FUNCTIONAL COMMUNICATION TRAINING FOR PROBLEM BEHAVIOR

reinforcement (escape from task) as well as positive reinforcement (access to preferred activities).

Return to Work from Break Time After a break that is slightly longer than the period of work completed, the learner will return to work. This can be a particularly challenging step. If possible, select reinforcers that can be accessed during the break that are consumed or naturally dissipate (e.g., play one video game or watch one cartoon) to minimize the struggle associated with disengagement.

TABLE 7.2.  Response Efficiency Analysis for a Child Who Is Taught to Request a Break Problem behavior

Less efficient response

Efficient response

Response effort Timmy throws materials after engaging in activities for brief periods of time.

A less efficient communicative replacement for Timmy would be to walk up to his teacher’s desk, tap her on the shoulder, and then sign “break.”

Following each instance of throwing materials, Timmy’s teacher approaches him and then releases him from the activity.

It would be inefficient from Timmy’s perspective if, when he emitted the communicative replacement, his teacher rarely responded.

Following each instance of throwing materials, Timmy’s teacher releases him and lets him roam about the room.

It would be inefficient from Timmy’s perspective if, after he touched the “break” symbol, his teacher merely gave him a brief time to rest.

An efficient communicative replacement from Timmy’s perspective would be to touch a symbol representing “break.”

Rate of reinforcement Timmy’s teacher approaches him and releases him to a break each time he touches the “break” symbol.

Quality of reinforcement When Timmy touches the “break” symbol, his teacher releases him and gives him access to a preferred item/ activity.

Immediacy of reinforcement When Timmy throws materials, his teacher immediately releases him to a break.

It would be inefficient from Timmy’s perspective if, when he touches his “break” symbol, his teacher says “Just a minute, Timmy,” and then forgot to release him to a break.

Timmy’s communicative replacement would be efficient if, immediately after Timmy touched the “break” symbol, his teacher released him to a break.

Requesting a Break 173

Select Reinforcer(s) That Can Be Obtained Only after a Successful Return to Work Once arriving back at work, the interventionist should not rush the learner. After several minutes (or when the reinforcer has been consumed), say, “Let’s get going, it won’t be long until another break.” Once this history has been well established, begin teaching a request for a break.

Prompt the Break Request Once a history has been established in which the child can successfully be released from the activity without problem behavior, the interventionist can begin to teach a break request. The form of the prompt utilized will depend on the communicative mode that has been chosen. When relying on speech, it is important that the individual reliably act on a spoken model. Alternatively, raising one’s hand is a very functional gesture that is readily understood in classroom settings. Often, with candidates for an augmentative communication system, a graphic symbol has been useful. In the remainder of the procedural steps presented, we describe the implementation of a graphic symbol, continuing with Timmy from Chapter 6 (see Table 7.2) as the example. Just prior to the critical event, the interventionist should deliver an instructional prompt for the child to request a break. With a graphic symbol, this can be accomplished by placing the symbol in front of the child just prior to release to break. Allow several seconds for the child to touch the symbol. If he or she does not, deliver the least intrusive prompt that culminates in quickly touching the symbol. As soon as the symbol is touched, release the child to his or her break. Typically, most-to-least prompts are used if the child does not attempt to escape the instructional prompt. Quickly prompting a response approximation during the early phases of intervention typically enhances the efficiency of the new communicative alternative from the child’s perspective. It is important to avoid prompting or reinforcing a break request immediately following problem behavior. This could lead to the chaining of the break request to the problem behavior. Another undesirable possibility is that the learner will first engage in throwing materials and then, if not immediately reinforced, produce an acceptable break request. If problem behavior occurs before an acceptable communicative alternative is produced, the interventionist should either refrain from releasing the child to a break, or wait until problem behavior has subsided prior to providing another opportunity to produce a break request (the length of time the interventionist waits is determined on an individual basis). The reason for this wait is that the interventionist does not want to encourage a chain of

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FUNCTIONAL COMMUNICATION TRAINING FOR PROBLEM BEHAVIOR

behavior in which the learner believes that problem behavior actually triggers an opportunity to request a break.

Fade the Instructional Prompt Across teaching opportunities, prompts should be systematically faded. This may be accomplished by (1) gradually reducing the magnitude of physical assistance, or (2) gradually delaying the delivery of the instructional prompt.

Gradually Make the Break Symbol Available Earlier in the Task and Introduce a TFD Cue So far, the learner has learned that if he or she touches a “break” symbol as soon as it appears, a break will be delivered. Eventually, the learner will have a communication book/board/wallet that houses many symbols and will be available throughout tasks. Consequently, it is important to begin introducing the symbol earlier and earlier in the activity. When this is done, it is likely that the learner will touch the symbol as soon as it is available. Once independent break requests are consistently being produced, the interventionist should offer the “break” symbol slightly earlier than he or she is actually prepared to release the learner. When the “break” symbol is offered earlier, it is likely that the learner will touch it as soon as it appears in front of him or her. If the learner prematurely touches the “break” symbol, the interventionist should immediately deliver the TFD cue (e.g., “Just one more minute”) and then immediately deliver the release cue (“OK, we’re done”) and negatively reinforce the learner by releasing him or her from the activity. Across successive teaching opportunities, the amount of time between the delivery of the TFD cue and the delivery of the release cue can be systematically increased contingent on no problem behavior occurring during the interval between the child touching the symbol and being released to a break. Timmy has learned to request a break independently. Upon emitting the request a break response, his teacher responds, “Just one more minute, Timmy,” and then waits 10 seconds before delivering the safety signal and releasing Timmy from the activity.

Of course, it is possible that the learner could engage in problem behavior after the delay cue has been given but before the interventionist has released him or her from the activity. If this occurs repeatedly, the interventionist should reconsider the amount of engagement that is being

Requesting a Break 175

required after the delay cue is given; the level of participation may need to be decreased. As we mentioned in relation to Table 7.1, we also implement a response cost when this occurs. In this specific situation, the delay interval might be increased for problem behavior by adding tasks that need to be completed, or time on the clock. We usually attempt to use extinction initially and if that is not successful, either reduce the level of participation or implement the response cost procedure.

Increase the Degree of Participation in the Activity Eventually the “break” symbol should be available at the beginning of the activity. At some point, the interventionist may wish to teach the learner to more carefully consider when to use a “break” symbol. This may be accomplished by manipulating the consequences associated with a “break” symbol and with increased activity participation. The goal of this procedural step is to make the reinforcement value much greater if the learner decides to persevere in the activity. By doing so, the learner not only gains negative reinforcement (release from the activity), he or she also gains positive reinforcement (a highly reinforcing item/activity during the break). Alternatively, if the learner finds it necessary to request a break prior to the point at which a release cue would normally be available, provide only brief negative reinforcement (e.g., pushing chair away from work very briefly). In this option, the interventionist should explain that a highly preferred reinforcer will be available contingent upon completing a prespecified amount of work without taking a break. The interventionist should also explain that it is OK to take a break if it is needed, but that the negotiated reinforcer will not be available.

How Will You Know If the Program Is Working? It will be necessary to examine the learner’s progress over a period of time. An example of a request a break progress form is shown in Figure 7.2. On the progress form, the interventionist should keep track of the following data: „„The

student’s name, the activity, and the observer. prompting method used (physical, gestural, etc.). „„The prompt-­ fading strategy implemented (decreasing magnitude, time delay). „„The date of each opportunity. „„The antecedent for each opportunity to emit a request for a break response. „„The

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FUNCTIONAL COMMUNICATION TRAINING FOR PROBLEM BEHAVIOR

Student name:  Timmy

  Prompting method:  Physical prompt

Activity:  Art

  Fading method:  Decrease magnitude

Observer:  T. K. Level of Prompt Time or Distance

OR

at Which Response Should Be Emitted

Time of Prompt Delivery

Date

Antecedent

(circle one)

(circle one)

Challenging Behavior Emitted

10/24

Coloring

3 minutes, 45 seconds

Full

      

10/25

Coloring

3 minutes, 50 seconds

Full

      

10/26

Painting

3 minutes, 55 seconds

Full

      

10/27

Coloring

4 minutes, 0 seconds

Full

      

10/28

Painting

4 minutes, 5 seconds

Full

      

10/31

Coloring

4 minutes, 15 seconds

Full

      

11/1

Coloring

4 minutes, 25 seconds

Partial

      

11/2

Painting

4 minutes, 35 seconds

Partial

      

11/3

Painting

4 minutes, 50 seconds

Partial

      

11/4

Coloring

5 minutes, 5 seconds

Partial

      

11/7

Painting

5 minutes, 20 seconds

Partial

      

11/8

Painting

5 minutes, 45 seconds

Partial

      

11/9

Coloring

6 minutes, 0 seconds

None

      

11/10

Painting

6 minutes, 20 seconds

None

      

11/11

Coloring

6 minutes, 40 seconds

None

      

11/14

Painting

7 minutes, 5 seconds

None

      

11/15

Painting

7 minutes, 40 seconds

None

      

11/16

Coloring

8 minutes, 5 seconds

None

      

FIGURE 7.2.  Requesting a break progress form.

Requesting a Break 177 Percentage of 15-minute activity completed and occurrences of problem behavior

100

80

Percentage of activity completed

60

40

Problem behavior

20

0 1

2

3 4 5 6 Blocks of three opportunities

7

8

FIGURE 7.3.  Graphed data.

„„The

critical event at which the request for a break response should be emitted by the learner for each opportunity (circle as appropriate). „„The appropriate fading method used is circled and the level of prompt (full, partial, etc.) or the time of prompt delivery (immediate, 3-second delay, etc.) is recorded for each opportunity. „„The last column is used to record (mark with an “X”) challenging behavior if it occurs during an opportunity. Additionally, progress can be tracked by examining the visual display of the data in a graphed format. Figure 7.3 shows Timmy graphed data.

Summary This chapter focused on teaching a break request as a communicative alternative to escape-­motivated challenging behavior. Requesting a break is a plausible option when the learner is competent in an activity but the activity requires more engagement than the learner is currently providing. For individuals who are less competent in a particular activity, it is also an intervention option that could be used in combination with requesting

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FUNCTIONAL COMMUNICATION TRAINING FOR PROBLEM BEHAVIOR

assistance or a variety of other intervention options (e.g., TFD, as discussed in this chapter). There are a number of important considerations that can have an effect on the success in teaching a request for a break. First, it is imperative to have a strategy in place to make it attractive for the learner to disengage from the break. Second, it is important to establish the conditional use of a request for a break. This occurs when the learner either already self-­ regulates his or her behavior, or can be taught to do so. During requesting a break opportunities, one aspect of self-­regulation involves being able to delay reinforcement in order to obtain a more substantial or potent reinforcement package. Requesting a break must be made more attractive to the learner than his or her existing repertoire of challenging behavior. No longer reinforcing problem behavior enhances the reinforcement value of the new socially acceptable communicative alternative. Finally, in earlier chapters on protesting and requesting assistance, we have emphasized pragmatically distinct uses for each type of request. Requesting a break is implemented in situations in which the learner’s engagement will be enhanced with a brief respite or delivery of reinforcement for partial completion of a task with the expectation that the learner will return. It is important that the interventionist establish a clear and consistent operational definition of the function of requesting a break and not deviate from it.

Chapter 8

Teaching Communicative Requests as an Alternative to Problem Behavior Maintained by Attention

In the preceding chapters, we described how FCT can be conducted to

replace problem behavior with an appropriate communication response for behaviors maintained by negative reinforcement. In this chapter and in Chapter 9, we consider how FCT can be used to teach communicative alternatives for problem behavior maintained by positive reinforcement. These communicative acts function to gain or increase access to preferred outcomes such as attention, toys, activities, or edibles. Collectively, these outcomes can be considered to be “gain” functions, whereas the communicative acts associated with negative reinforcement can be considered to be “escape” functions. In this chapter, we describe how FCT can be used for the gain functions that involve requesting attention. Although tangibles (and edibles and preferred activities) and attention are both positive reinforcers, and are often part of one class of reinforcement (e.g., play together), we describe them separately in this chapter for three reasons. First, our experience suggests that some individuals, and especially those with autism, can appear to be obsessed with particular tangible items such as trains, specific videos, or computers. For those individuals, it is sometimes important that we separate attention from tangibles, as shown in the following case example. Gustavo’s parents reported that he often enjoyed his parents’ attention, but not when he was watching a favorite video. Rather than watching the entire video, Gustavo repeatedly watched the same scene over and over. If anyone,

179

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FUNCTIONAL COMMUNICATION TRAINING FOR PROBLEM BEHAVIOR

including his parents, were watching with him, he would turn away and then strike out at them. At all other times, he appeared to want his parents to play with him. For Gustavo, attention may have been reinforcing in some contexts, but not when he was watching specific scenes on specific videos.

Wacker, Harding, et al. (1996) provided another example of how attention and edibles interact with a young boy who engaged in severe problem behavior. From his parents’ perspective, the behavior appeared to occur randomly throughout the day. The authors showed in their analysis that just prior to meals, it appeared that (the MO was hunger) problem behavior was maintained by food. Just after meals, when he was full, the MO changed, and the same topography of problem behavior was maintained by attention. The occurrence of his problem behavior had puzzled his parents because sometimes food worked to “calm him down,” and other times, holding him “calmed him down.” As shown by Wacker et al. (1996), attention maintained problem behavior, but only when the child was not hungry. Second, a number of authors (e.g., McCord & Neef, 2005) demonstrated that highly preferred tangible items can compete effectively with attention. For example, during a functional analysis, attention from adults might be missed (false negative) if the learner has access to a highly preferred item. This might especially be the case if the learner does not always have access to the item (e.g., only has the item at home or school). In these instances, the learner may be highly motivated to have or play with the item following periods of time when the item is not available. When the learner is ignored in these situations, he or she may not be likely to be motivated by attention because of his or her access to a specific toy. For this reason, we often attempt to separate attention from items, activities, or edibles that are most preferred by the learner. Third, as discussed in Chapter 2, we want to identify the specific reinforcers that are maintaining problem behavior so that we can teach the learner a functionally equivalent, appropriate communicative response that replaces problem behavior (Carr, 1988). If we teach the learner to emit a greeting response to an adult to obtain attention, we want to know that attention is actually the reinforcer and not what the adult brings with him or her. For example, assume that when the greeting is directed to his or her dad, the learner always receives high-fives and tickling. However, when the same greeting is directed to his or her mom, the learner receives a cookie. If the parents report differences in responding (e.g., “He likes his mom more than me”), the active variable might be the activity/edible rather than the attention. As we extend and generalize FCT across settings and other adults, we may encounter problems because we misidentified the specific response–­reinforcer relation.

Requests as an Alternative to Problem Behavior Maintained by Attention 181

Communicative Requests for Attention and Tangibles and Their Early Development As stated earlier, requests to gain or maintain attention and tangibles are maintained by positive reinforcement, which means that the learner’s behavior (e.g., saying, “Please”) is reinforced by the receipt of or continued access to an event, person, activity, or other stimuli that are preferred by the individual. Developmental evidence suggests that requesting emerges as one of the earliest communicative functions among typically developing children (Crais et al., 2004). Early on, we know that although older toddlers are most attracted to novelty, young infants appear to be attracted to events with which they are familiar. For example, 2-week-olds display a preference for the smell of their own mothers and also show a preference for their mothers’ face (Field, Cohen, Garcia, & Greenberg, 1984; Walton, Bower, & Bower, 1992). Sometime between 4 and 6 months of age (with substantial variability) infants begin to initiate attention-­procuring acts to adults (Aslin, 1987). Improved ability in sustaining mutual gaze between care provider and child along an increasing distance over which these coordinated gaze exchanges can occur likely facilitates child attention-­seeking behavior (Papousek & Papousek, 1977). Adults begin to conclude that children are seeking their attention via conventionalized gesturing and joint attention (Bates et al., 1979) near their first birthday. At about this time, Bates (1976) reported the emergence of protodeclaratives. These are communicative acts in which events that are of interest to the child are brought to the attention of a communicative partner and represent the first clear-cut evidence of obtaining adult attention that is separated from attempting to use an adult as a “tool” to procure a good or a service.

FCT for Problem Behavior Maintained by Attention Unique Problems Associated with Attention‑Maintained Problem Behavior Thus far, the maintaining class of reinforcement that we have discussed was negative reinforcement. The learner was presented with an object, event, and so on that increased the learner’s motivation to avoid or to escape that stimulus. Although the specific communication functions for negative reinforcement can be complex to treat via FCT (as shown in Chapters 5–7), the situation that evokes problem behavior is often known. Put another way, the MOs underlying escape responding are often quite apparent as the learner reacts to the presence of specific demands or situations. In many of these situations, the care provider schedules these events. For example, at school, the teacher may know which academic tasks are most often

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FUNCTIONAL COMMUNICATION TRAINING FOR PROBLEM BEHAVIOR

correlated with problem behavior; at home, the parent may know which chores evoke problem behavior. When the care provider can predict when problem behavior will most likely occur, this permits the care provider to prepare for displays of problem behavior. For example, at school, the teacher might have a colleague present to assist with following through with the demand (i.e., escape extinction), and at home, the parent might have another adult present during times when the MO for negative reinforcement is present. Following through with the demand is often the hard part; it is relatively easy to determine when problem behavior will occur. The situation can be much different with attention-­maintained problem behavior because there is often a highly individualistic response to not receiving attention—­that is, some learners appear to be motivated to obtain constant attention, while others have different levels of desired attention. Wacker, Harding, and Berg (2008) showed this individualistic pattern of responding with three young children whose problem behavior was maintained by attention. All three children were taught to mand (request) to gain attention. Sometimes they received low durations of attention and other times high durations of attention. As expected, all three children adjusted their frequencies of manding based on the length of attention received. However, all three also maintained specific levels of attention, with one requesting small levels of attention, one requesting a moderate level of attention, and one close to a continuous level of attention. Thus, as discussed by Wacker et al. (1990), there are often highly individualistic patterns of deprivation and satiation that underlie a learner’s motivation for attention. A second aspect of attention that can make it distinct from both negative and tangible reinforcement is that the motivation for attention often occurs at very inconvenient times for the care provider. Parents often discuss with us how hard it can be to care for other family members, prepare meals, or take care of personal needs when they have a child who frequently requests attention. These are, of course, the times when attention is most likely to be desired because the child is being ignored, but they are also the times that are the most difficult to provide the desired levels of attention. A third aspect that can distinguish attention from other functions is that learners often respond differently to different types of attention. For example, Gardner et al. (2009) showed that different qualities of attention could affect the compliant behavior of children whose problem behavior was maintained by escape from work tasks. The authors showed that when high-­quality attention was provided by a clinic therapist contingent on working, children chose to complete even nonpreferred tasks over playing alone and escaping the task. Thus, high-­quality attention, but not low-­ quality attention, can abolish a learner’s motivation to escape a demand

Requests as an Alternative to Problem Behavior Maintained by Attention 183

(assuming that attention functions as a reinforcer for the learner). These three aspects of attention-­maintained problem behavior—­lack of predictability, timing, and type—all make FCT treatment for attention uniquely challenging.

Problems with Punishment and Prevention Parents often tell us, “Punishment does not work”; the learner simply continues to engage in the problem behavior. Alternatively, parents sometimes say that “Punishment only works for a little while and then the child starts engaging in problem behavior again.” Sometimes parents and teachers think they are punishing behavior when they are actually, but inadvertently, reinforcing the behavior. In Table 8.1, we provide examples of how problem behavior can be inadvertently maintained by positive reinforcement (see also Wacker, Berg, & Harding, 2002). In all three cases in Table 8.1, problem behavior resulted in contingent (and most likely, immediate) positive reinforcement in the form of parent attention. In each of these three cases, reinforcement of problem behavior was inadvertent; the parent meant to punish (reprimand) the child. However, from the child’s standpoint, the problem behavior functioned as a mand in that it served to request desired outcomes that were received, thus reinforcing the problem behavior. Because reinforcement was received, problem behavior temporarily stopped. However, because it was reinforced, the behavior will almost certainly occur again in the future whenever the learner is sufficiently deprived of attention. Although most young children engage in problem behavior that produces positive reinforcement, one difference between most children and those we work with

TABLE 8.1.  Problem Behavior Inadvertently Maintained by Positive Reinforcement That Was Considered to Be Punishment Behavior

Procedure

Functional outcomes

Hitting parent

Parent reprimands child.

Increased attention from parent. Problem behavior stops temporarily due to satiation.

Severe tantrum/ meltdown when leaving for store

Parent cancels shopping and instead discusses why behavior was wrong.

Increased attention from parent; problem behavior stops due to satiation.

Aggression toward peers at playground

Parents removes child from playground and returns home.

Increased attention from parent; problem behavior stops due to satiation.

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FUNCTIONAL COMMUNICATION TRAINING FOR PROBLEM BEHAVIOR

is the repertoire of socially acceptable communicative acts. Most children have dozens and perhaps hundreds of both vocal and nonvocal communicative responses they can use to appropriately request attention. As they acquire more appropriate communication, their care providers also begin to insist that they use their communication. However, among persons with severe intellectual and/or communication disabilities, this may not be the case. To illustrate this point, consider the following scenario that most of us have witnessed (and perhaps also experienced). A mother carries a toddler into a fast-food restaurant on her shoulder, and for whatever reason the child begins to scream and perhaps even bites his or her mother. The mother responds by firmly setting the child down and sternly saying, “Don’t bite me; use your words!” After a brief period of time, the child communicates vocally and is then happily ordering or eating.

In the preceding scenario, the child had a sufficient vocal repertoire to communicate what he or she wanted, and the mother waited until ­appropriate communication occurred. Most of the learners we work with have very limited communicative repertoires and often have many more problem behaviors than they do appropriate communicative behaviors. Because their care providers are often uncertain about what the learner wants, they may attempt to identify the desired event without requiring the learner to first communicate appropriately. In other words, they try to prevent the problem behavior from occurring. This may be in an effort to escape the aversiveness of the child’s problem behavior (or to escape the embarrassment of their child’s problem behavior being produced in a public environment). From the standpoint of the care provider, the child may not be able to communicate appropriately and giving the child what he or she wants is done to get the problem behavior to stop—that is, the care provider’s “giving-­in” behavior is negatively reinforced by the discontinuation of the child’s problem behavior. This situation may be exacerbated by the adult not having knowledge of the range of prompting strategies or the alternative communicative means that could be taught as alternatives (see Chapter 2). Thus, providing the desired item or event for problem behavior serves to strengthen two sets of behaviors that include (1) the problem behavior produced by the child is strengthened via positive reinforcement, and (2) the provision of reinforcement to the child by the parent is strengthened via negative reinforcement because it temporarily stops the problem behavior. The negative reinforcement received by the care providers needs to be considered when recommending interventions. Telling a parent to ignore behaviors such as self-­injury may be very difficult for several reasons. It is difficult to watch someone you care about engage in these behaviors.

Requests as an Alternative to Problem Behavior Maintained by Attention 185

Displays of problem behavior in public can be embarrassing and can result in strangers making unwanted and unhelpful comments. These problem behaviors can ruin family activities. Additionally, ignoring is apt to result in an extinction burst (originally described in Chapter 5) in which the learner’s behavior escalates for a period of time before it begins to decelerate. As Wacker et al. (2011) demonstrated, extinction bursts can continue to occur even after long periods of FCT intervention. As mentioned previously, the MO for attention can be highly individualistic and thus it is difficult to determine how long the extinction burst will continue. Recall also that type of attention can be discriminated by the learner. The parent may think he or she is not attending, but the learner may discriminate that he or she has the parent’s undivided attention. This, in turn, may increase the length of the extinction burst. Even professional interventionists often have a difficult time withstanding extinction bursts. For a wide range of reasons, problem behaviors maintained by attention may be reinforced at least intermittently and can continue to occur for very long periods of time. Given that both the timing and the duration of problem behavior are problematic, it is easy to see why care providers consider punishing the behavior (see Table 8.1). As an alternative to punishment, care providers may also consider prevention. Unfortunately, as was the case with punishment procedures, care providers may be inadvertently reinforcing problem behavior when they think they are only preventing it. In Table 8.2, we provide three TABLE 8.2.  Problem Behavior Inadvertently Maintained by Prevention Strategies Prevention strategies

Short-term effect on learner

Long-term effect on learner

Learner is given attention for yelling.

Prevents the more severe behavior of aggression.

Both yelling and aggression are strengthened, and will more likely occur in the future because they are members of the same response class.

Learner is provided with constant attention.

No problem behavior occurs.

Learner does not learn alternative responses to aggression and so aggression will likely occur in the future whenever MO for attention is present.

Learner is given highly preferred items/edibles whenever attention is not available.

Aggression will not occur as long as the items/edibles compete effectively with attention.

Learner does not learn to selfregulate, and so aggression occurs whenever waiting occurs without access to the preferred item/edible.

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examples of how prevention can inadvertently be reinforcing the target response of aggression. As with the “punishment” procedures, the prevention procedures in Table 8.2 all inadvertently reinforce aggression, and thus increase the longterm probability that aggression will continue to occur. In the first example, aggression is indirectly reinforced because it is in the same response class as yelling. As discussed in previous chapters, if one member of the response class is reinforced, all members will be reinforced. If yelling and aggression are correlated (tend to co-occur or occur in a two-step chain), then this “preventative” procedure is actually a reinforcing procedure. The second example in Table 8.2 is fine in that problem behavior is not being reinforced. The problem is that the learner may never acquire an appropriate repertoire for requesting attention. If we assume that attention will continue to be reinforcing for at least the foreseeable future, and that constant attention will not always be available, then it is imperative that we teach socially appropriate behavior, including requests for attention. One approach that we often recommend is to blend a version of constant attention called noncontingent reinforcement (NCR; or scheduled attention) with FCT. Consider the following case example. As his mother told it, 3-year-old Bobby, with severe intellectual disability, was a semipermanent fixture on her hip. From the moment he awakened in the morning to going to sleep at night, he demanded his mother’s attention. Bobby had severe self-­injury in the form of head banging that was maintained by attention. He had little interest in toys and no recognizable communicative responses. Bobby engaged in self-­injury “from the second” he was ignored. Our observations in his home confirmed this statement: He rarely lasted more than 2–3 seconds without self-­injury if his mother turned away from him. She could not put him down without self-­injury occurring.

We based our treatment on combining NCR with FCT. Reed et al. (2005), for example, showed that NCR could be scheduled to reduce the motivation to engage in a problem behavior (because it reduced the value of the functional reinforcer), but not so much that it lost its reinforcing effects. As shown by Richman et al. (2001), if the learner has two or more responses to mand for reinforcement, the learner will most often choose the more efficient response. With Bobby, we wanted to schedule attention to occur at least every 5 seconds, but in between he could appropriately request attention. Requesting for attention needed to be more efficient than self-­injury. For his appropriate mand, we chose signing “please.” We chose this response because it was easy for his mother to prompt (he did not resist physical contact from his

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mother). Sitting on her lap allowed her to gently guide his hand to his chest, for which he received high-­quality attention. In between prompts to sign, he was given almost continuous but more neutral attention. This schedule of noncontigent attention was decreased over time, requiring that he wait for increasingly longer periods of time. We also required that Bobby (1) not engage in any problem behavior while waiting for attention, and (2) that he become increasingly independent in signing “please.” Over approximately a 2-year period, he became very independent in signing and began to vocally say “Mom.” This led to an explosion of oral vocabulary.

The challenge in combining NCR with FCT is to have the right schedule of NCR. Marcus and Vollmer (1996) provided an example of how time-­contingent reinforcement schedules1 could be blended with FCT for problem behavior maintained by positive reinforcement. They showed that functional communication could be taught as long as the time-­contingent reinforcement was not too dense (i.e., occurred too often). If it was too dense, the children were not motivated to learn or to display appropriate communication, likely because the value of the reinforcer was diminished by the frequency with which it was freely available. Thus, when setting up an FCT program, we blend in schedules of time-­contingent attention and access to preferred items on as lean a schedule as possible. When we develop time-­ contingent programs, we first observe the problem behavior of interest to determine its rate, or the duration of time that occurs between episodes of the behavior. When we know the rate, we provide the time-­contingent reinforcement at a comparable rate if possible. For example, if a child displays problem behavior approximately every 10 minutes, attention might be scheduled to occur every 9 minutes unless FCT intervention is occurring. If FCT intervention is scheduled, then the adult would create situations that involved the child waiting for 10 minutes and teaching the child either to wait or to appropriately request attention. Marcus and Vollmer (1996) showed that this type of combined treatment substantially reduced problem behavior without disrupting the acquisition of appropriate behavior, including appropriate communication. The first step is to observe how frequently problem behavior and reinforcement are occurring. Schedule reinforcement to occur just before an instance of problem behavior is expected—­this will reduce the occurrence of problem behavior. Provide the smallest amount of attention possible with the least quality during these scheduled attention times. For appropriate behavior such as 1 Although

the label “noncontingent” is the more common term, some authors prefer the label “time-­contingent” to describe these schedules because time-­contingent is technically more accurate; reinforcement is provided after a period of time regardless of behavior.

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mands, however, it is desirable to provide a much higher quantity and quality of attention. Over time, we expect the learner to choose the appropriate communication response over problem behavior because it is more efficient and it results in greater amounts of high-­quality attention than does problem behavior. Thus, we schedule just enough attention to occur to reduce problem behavior from occurring (or the intensity with which it occurs), but not so much that the learner is not motivated to request more attention. Peck et al. (1996) provided a demonstration of how children’s choices can be altered by the quantity and quality of attention they receive. In their study, some of the children’s problem behavior was shown to be maintained by attention. The children then either received small amounts of low-­quality attention for problem behavior or a neutral response, and much greater quantities and qualities of attention for appropriate behavior. Peck et al. (1996) showed that even very young and very sick hospitalized children responded positively to this form of choice treatment in that they quickly learned to engage in the responses that produced the highest amount and quality of attention. If we follow the advice of Mace and Roberts (1993) and view all behavior as constituting a choice, then one option for FCT treatment for attention is to vary the quality and/or quantity of attention provided for appropriate communication and problem behavior. Neef et al. (1992) showed choice responding can be altered by changing the quality or amount of the reinforcer associated with each choice. Peck et al. (1996) used this approach to decrease problem behavior by biasing the children to choose appropriate behavior over problem behavior. They chose appropriate behavior because it was associated with higher qualities and quantities of attention. In the following case example, we show how choice responding can be used as an active component of FCT. Anab was an adolescent with moderate intellectual disabilities who engaged in loud and repetitive vocalizations to obtain attention from her mother after she arrived home from school. Her mother decided that she would offer Anab the choice of low-­quality but immediate attention (e.g., activities such as helping her wash the dishes, which is not one of Anab’s most favorite activities). Alternatively, if Anab was willing to wait 1 minute, she could access high-­quality attention (consume a beverage at the dining room table with her mother and visit for a longer time period than it took to complete the chore that was paired with immediate attention). Anab immediately chose the activity that provided higher-­quality attention. During the next intervention phase, Anab was taught to chain a polite invitation for her mother’s attention at the end of the specified “wait time.” Across successful opportunities, the wait time that Anab experienced prior to the opportunity to request “high-­quality attention” was systematically increased. The length of the wait time for Anab was signaled by having her

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mother set an alarm on Anab’s watch as she told her that she would be busy getting work done so that she could have time with Anab. As soon as the alarm sounded, Anab could say, “Come get me and we’ll visit.” Eventually, Anab’s frequency of problem behavior to obtain attention decreased as she learned that latency without attention that resulted in an opportunity to obtain higher-­quality attention was preferable to lower-­quality attention that occurred more often.

Considerations for Teaching Appropriate Communicative Requests for Attention MOs As mentioned previously, one difference between behaviors that are maintained by positive reinforcement when compared with behaviors that are maintained by negative reinforcement relates to MOs. For negative reinforcement, the MOs that increase the learner’s motivation to avoid or escape the situation are often known and are sometimes controlled by the care provider. Consider the case examples of two preschool students in the same class, Sheng and Rudy. Sheng’s problem behavior consisted of biting himself and others. He bit only when he was given difficult academic tasks at school and when he was told to complete similar work at home. Thus, nonpreferred demands were MOs for problem behavior, which was most likely maintained by negative reinforcement in the form of escape from demands. Sheng’s parents and teachers could predict when he was most likely to emit problem behavior and to consider their options prior to presenting one of these demands to him. Because they could predict when problem behavior would occur, they could schedule times to treat problem behavior with FCT. His teacher and mother met and developed a specific behavioral intervention plan (BIP) for both school and home. At school, the teacher selected four times per day when she would work on teaching Sheng to request assistance. His mother picked two times at home. They developed a data sheet to track his progress and two sets of identical materials (e.g., first/then visual schedule and “help” card). This level of specificity was possible because they could predict the MOs that established escape as a reinforcer. By teaching Sheng to touch the “help” card, they were able to quickly reduce both his self-­injury and aggression. Now consider the case of Rudy. Rudy’s problem behavior occurred periodically throughout the day in all settings. He had poor play skills and never played by himself. Rudy never engaged in problem behavior when he was with adults, even if that meant he was doing nonpreferred tasks. However, if not one-on-one with an adult, he was likely to engage in problem behavior at some point, but not always right away. Thus, the absence of attention was an MO for problem behavior that was most likely maintained by adult attention.

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One of the difficulties in intervening with Rudy is that his care providers could not be certain when his problem behavior would occur. For most learners like Rudy, attention deprivation builds up over time. Consequently, care providers are not certain when problem behavior may occur. As mentioned previously in this chapter, this can increase the probability that the intervention will involve as much one-on-one attention as possible (assigning an aide to work with him). When one-on-one attention is not available, it is likely that adults will most often only attend to problem behavior because so much of their time is devoted to dealing with the problem behavior. When problem behavior is not occurring, the adult is motivated to attend to other duties and to other students or children. Thus, unlike the previous case example, the same teacher and parent cannot be as specific in their BIP because problem behavior is not always predictable. For some children, such as Bobby in the earlier example, problem behavior occurs immediately whenever attention is diverted or restricted. In these situations, as described for Bobby, a combination of NCR plus FCT can be implemented with wait times gradually extended over time (see the top row in Table 8.3). A second option, shown in the middle row of Table 8.3, is to schedule learning opportunities in which the MO for attention is increased in a controlled fashion. Hanley, Heal, Tiger, and Ingvarsson (2007) noted that “controlled exposure” (p. 278) to situations that occasioned problem behavior was an important component of a preschool program designed to teach functional communication skills to preschool children. Rather than attempting to always prevent problem behavior from occurring, they set aside activities and times when problem behavior was most likely to occur so that the teacher could teach the child appropriate skills, such as using functional communication. Thus, the teacher might divert his or her attention, but do so in a highly controlled manner that optimized success. For example, with a child who touches a word card, the teacher might say, “I’m going to read this book. If you want to play, touch this card.” The teacher would then prompt the child to touch the card (prompting strategies were addressed initially in Chapter 4), say, “Great job touching the card. Yes, let’s play!” and then provide 1–2 minutes of high-­quality attention. After playing for 2 minutes, the teacher would then look away, ignore or block problem behavior, and periodically prompt the child to request to “play.” In our FCT programs, we then require the learner to independently produce the communication response to obtain high-­quality reinforcement after the initial demonstration. After the demonstration, which always starts each practice session and always ends with high-­quality attention regardless of the prompt, we restrict high-­quality attention to those trials in which the learner has emitted an independent response. By independent, we mean without physical guidance or a visual model (beyond the initial demonstration). We wait for a specified interval (e.g., 10 seconds) before we provide

Requests as an Alternative to Problem Behavior Maintained by Attention 191 TABLE 8.3.  Options for Implementing FCT for Attention-Maintained Problem Behavior Procedure

Description

Rationale

Effects on learner

Combine FCT with NCR and increase wait time.

Teach learner to request attention after waiting for gradually extended periods of time, with initial waiting times being “easy” for the learner.

Directly teach learner to wait.

NCR reduces MO for attention but then is faded as learner becomes more independent in waiting and manding.

Schedule FCT in a controlled manner.

Provide teaching opportunities for learner to practice manding.

Cannot always predict when MO is sufficient for problem behavior to occur and so schedule “practice” times (can combine with general case generalization strategies).

Scheduled teaching times function as NCR and thus reduce MO for attention; increase communication repertoire.

Teach learner to request a highly preferred toy.

When attention will be diverted, prompt learner to request access to a highly preferred item.

For some learners, access to highly preferred items abolishes MO for attention.

Reduces probability of problem behavior; increases communication repertoire.

additional prompts to give the learner a chance to independently communicate by touching the card. If the learner touches the card within those 10 seconds, the learner receives high-­quality attention for 2 minutes (see Peck et al., 1996, for a further description of this procedure). Otherwise, the learner first receives a model or gesture (e.g., pointing at the card) and then physical guidance to touch the card. If either a visual or physical prompt is needed, the learner receives only 10 seconds of neutral attention before being given another opportunity to mand independently. We use this type of time delay prompting because we want the learner to become as independent as possible. Because the functional reinforcer is adult attention, we need to be careful using physical guidance as a prompt, as the learner may enjoy receiving physical contact from a preferred adult. If the learner receives the same amount and quality of attention following physical guidance as for more independent communication, this might reduce the learner’s motivation to learn to communicate independently.

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A second variation to consider involves increasing the delay to reinforcement if physical guidance or modeling is used as the prompt. Rather than altering the quality/quantity of attention for more versus less independent mands, the interventionist could also increase the delay prior to the learner receiving reinforcement. This could be accomplished, for example, by increasing the interval between prompts. As mentioned previously, we often wait 10 seconds (a very small delay) prior to delivering the next prompt. We could instead wait 30 or more seconds, thereby greatly increasing the learner’s delay to receiving attention. As discussed by Mace and Roberts (1993), delays to reinforcement, just like alterations in effort, and in the quantity and quality of attention, can motivate learners to choose one response (e.g., independent manding) over another (e.g., physically guided manding). Neef et al. (1992) showed that changes in any of these dimensions of reinforcement can alter choice responding, and so delays to reinforcement can be a highly effective component of FCT. Unfortunately, with learners who display severe problem behavior, these delays can be correlated with a high rate of high-­intensity problem behavior. If the interventionist is not prepared to ignore or block problem behavior during the wait interval, then increasing the delay to reinforcement will not be possible, at least initially. As we discussed for Bobby, we will often first intervene by altering the quality and quantity of reinforcement, and then alter delays once the learner is independently communicating. Although we have described the controlled exposure procedure for attention-­maintained problem behavior, it is also a very good approach for both escape- and tangible-­ maintained problem behaviors. With problem behavior that is reinforced by negative reinforcement, the adult would present demands and work on the strategies discussed in the previous three chapters. For behavior maintained by access to a tangible, scheduled times would occur when the item was restricted and the strategies discussed later in the next chapter would be implemented. Across all functions, by scheduling these times, the adult can be prepared to respond appropriately to the problem behavior and to make sure that the appropriate intervention is being practiced several times per day. During other times of the day, interventionists can arrange the environment to reduce the occasions of problem behaviors by providing attention or tangibles on a noncontingent (scheduled) basis. As discussed previously, provision of reinforcers such as attention on fixed or variable time schedules can reduce the MOs for problem behavior by reducing the child’s deprivation for attention. The tricky part of blending time-­ contingent schedules of reinforcement within an FCT program is that we do not want to provide so much “free” reinforcement that the child is not motivated to learn functional communication, but just enough that displays of problem behavior are reduced.

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The third option shown in Table 8.3 is to teach the learner to request a highly preferred toy or item during the wait interval. Thus, rather than (or in addition to) teaching the learner to request attention, it may be more efficient to initially teach the learner to request a specific item. As mentioned previously, highly preferred items can sometimes compete effectively with attention. For example, McCord and Neef (2005) showed that an attention function was missed during a functional analysis if the participant had access to highly preferred items. We have observed clients choosing to play alone with a highly preferred item rather than to receive attention, especially when attention was paired with demands. However, when that specific item was not available, attention once again became a reinforcer for complying with those same demands. Thus, access to a highly preferred item can temporarily abolish the learner’s motivation to gain attention. Sometimes we select this treatment option if we observe one of two assessment results: (1) the attention function of a problem behavior in a functional analysis is abolished by the presence of a preferred tangible item, or (2) the learner chooses the tangible item over attention during a concurrent-­operants preference assessment (Harding, Wacker, Berg, Baretto, & Rankin, 2002). Another reason to select this treatment option is that we have often found it easier to teach learners how to request an item than to request attention. There are at least three reasons why teaching a client to request an item is easier than attention. First, with a tangible item, one teacher or parent can conduct the training, whereas two adults are often needed for attention. For example, if the learner engages in problem behavior only when the care provider is leaving the room, then some other interventionist needs to prompt the communication response. This is especially the case if the communication response involves a manual response such as signing, touching a word card, or pressing a key or switch. Second, many learners value the attention of some adults much more than others. Thus, training can occur only when specific adults are available and those adults have the support of others to prompt the appropriate response. Third, we have often found that there is a bit more of a delay between the removal of an item and displays of problem behavior than when attention is diverted. A delay of even a second or two permits the interventionist to prompt the desired communication response prior to displays of problem behavior. When we set up this program, we conduct the following steps. The adult and learner play together for a minute or two. Schedule enough time for the learner to become involved with the toy or activity, but not enough that the learner becomes satiated. In order to determine this schedule, conduct the same type of descriptive assessment as described for NCR procedures. For example, if the learner will generally pause for 30 seconds before engaging in problem behavior, once attention has been diverted, prompt

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the request within that 30-second period. If the learner satiates on the toy after 10 minutes, then make sure that 10 minutes has elapsed to increase the probability that attention (or an alternative item) is reinforcing. After playing briefly with the item, the interventionist says something like “If you want to keep playing with       , touch this play card,” using the same prompting strategies of vocal, visual, and then physical prompts. The learner then receives or maintains access to the item after appropriately communicating. In this case, access to the item is provided even following physical guidance, because the goal is for the adult to briefly turn away from or leave the learner. After the time has elapsed, the adult returns. If the learner does not independently request attention, the adult says something like “I can play now. Tell me if you want me to play.” When first teaching the learner to request to play, we quickly prompt the appropriate communication to avoid escalations in problem behavior (e.g., because the learner is becoming satiated with the toy). Over time, we require the learner to communicate independently. For example, the adult might say, “I can play now,” and then waits 5–10 seconds for the learner to make the request. If the request is not made, the adult says, “I’ll check back with you in a minute,” and then briefly leaves or diverts his or her attention again. Over time, the learner is taught (1) to wait for increasingly longer periods of time prior to receiving the item; (2) to wait for increasingly longer periods of time between finishing with the item and receiving attention; and/or (3) to request new items to play with, thus increasing the overall amount of time he or she is without attention. For options (1) and (2) above, as discussed in Chapter 4, the learner will need to be signaled when attention is available. We want the learner to discriminate when requesting attention will be reinforced and when it will be ignored. There are two main reasons why we want to teach the learner not only to mand but also when (under what conditions) to mand. First, we most likely will want to reduce the overall amount of attention the learner receives over time. Reducing the overall amount of attention is best accomplished through schedule thinning (Hagopian et al., 1998; Hanley et al., 2001). With schedule thinning, we progressively increase the delay between opportunities to request attention. As Hanley et al. (2001) showed, this can be accomplished through signals. In our FCT projects, we accomplish this via word cards or voice output devices. From the very beginning of FCT, we have a “play” or “mom” card that is placed in front of the child. When this card is present, all appropriate communication is reinforced. During other times, including during reinforcement intervals, the card is removed and communication is ignored. We do this to teach learners to conditionally use their communication to maximize the efficiency of their communication and not “waste” it. Over time, we gradually reduce (fade) the presence of the card until we have reached the schedule of reinforcement that we intend

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to stay with for the immediate future. Signaling when a communication response will be reinforced also assists with maintenance. We do not want the learner’s appropriate communication to be placed on extinction because this would weaken the behavior over time. Hagopian et al. (1998) showed that another way to reduce overall amounts of positive reinforcement is to increase the time between the emission of the communicative response and the delivery of reinforcement. Over time, progressively increasing this interval reduces the overall amount of reinforcement provided. We accomplish this reduction in two ways. First, when an appropriate request is made, we hold up an index finger before delivering the reinforcer (a delay cue or signal; see Chapter 4). Initially, the delay between holding up an index finger and providing attention is almost instantaneous. Progressively over time, we increase the delay interval. Second, we also often use kitchen timers or visual timers to signal that a delay period is over. When attention is requested, we hold up an index finger and then set the timer (delay cue in a tolerance for delay of reinforcement procedure described in detail in Chapter 4). For example, if the parent reenters a room where the child has been playing alone, the following sequence may occur. The child immediately requests attention. The parent thanks the child for asking, sets the alarm for 1 minute, and then returns to play as soon as the alarm sounds. The second reason we want to teach the learner when to mand is that we want manding to be strengthened relative to problem behavior. It will most likely not be possible to prevent problem behavior from occurring except during “controlled exposure” times, and this is especially true at the beginning of FCT. Factors that are related to displays of problem behavior are the strength of problem behavior in relation to appropriate communication, the child’s proficiency in displaying appropriate communication, the relative efficiency of appropriate communication versus problem behavior, and the consequences for both problem behavior and appropriate communication. Nevin (1974) showed that a behavior that had received a high rate of reinforcement over a long period of time was often resistant to changes in antecedent and consequence stimuli (e.g., problem behavior persists even with the introduction of FCT). This resistance is referred to as response strength (Nevin & Wacker, 2013). Relative to FCT, the goal is to decrease the rate of responding of problem behavior while increasing the occurrence of appropriate communication. When problem behavior has a history of a high rate of reinforcement, it will be more likely to resist the FCT treatment—­that is, it will continue to occur, even if it is put on extinction. This persistence will be increased if reinforcement of problem behavior continues to be provided, and initially, even when appropriate communication is reinforced, because communication and problem behavior are in the same response class. One outcome of this situation is that FCT takes a

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very long time before there are consistent reductions in problem behavior (Wacker et al., 2011). Although many studies have quickly reduced problem behavior during scheduled FCT (controlled exposure) sessions, when FCT was not in place, problem behavior quickly showed resurgence. Wacker et al. (2011) showed that FCT often took months before the effects of treatment generalized to times when the appropriate behavior received even brief periods of extinction, or the various components of treatment could not be immediately conducted (e.g., word card not available). With attention-­maintained problem behavior, there will almost certainly be times during the day when appropriate communication cannot be reinforced immediately because care providers are doing other activities. As Nevin and Wacker (2013) have explained, the goal of intervention should be that the desirable effects of intervention (e.g., appropriate communication, appropriate task completion or play) persist during these times and problem behavior does not reoccur. Intervention should continue, then, until appropriate behavior shows good strength and problem behavior is weak. This means that intervention will need to be continued for much longer than is often the case. As shown by Wacker et al. (2011), a 90% reduction in problem behavior occurred almost immediately with FCT, but it took several more months before appropriate behavior continued and problem behavior did not resurge during even brief periods of extinction. FCT sets up a competition between appropriate behavior—­including communication and problem behavior. Each time one response is reinforced, that response gains strength relative to the other response. Each time one response is ignored, it is weakened relative to the other response. The more we can strengthen appropriate communication, the better it will compete against problem behavior. Unfortunately, as shown by Wacker et al. (2011), it may very well take a long time before appropriate behavior competes effectively against problem behavior, and especially outside of training situations. In the following sections, we consider additional factors that may aid us in speeding up the results of this competition.

Proficiency of the Child’s Use of Appropriate Communication Pediatric outpatient clinics at The University of Iowa evaluate the behavior of individuals who display severe problem behaviors. At least once a month, and usually more often, a child comes to the clinic without his or her communication system. We are told that the system stays at school, is not used at home, or is “broken.” When we decide to conduct FCT, we have to recognize that the system works only to the extent that the child has access to the system and can use the system independently. Wacker et al. (1990) referred to this as a control function of FCT. Recall that we

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previously discussed that the motivation to engage in behaviors that result in positive reinforcement are controlled, in part, by MOs. Relative to attention, the child experiences a certain level of deprivation that is sufficient to seek out attention. The child does this by engaging in behaviors that have historically produced or been paired with attention. As we just discussed, if appropriate communication has more strength than problem behavior, the child will likely select this response to emit. In the ideal world, this is what would occur. The child experiences momentary changes to states of satiation and deprivation, and responds to those states by appropriately requesting events, actions, and stimuli that resolve these states. Appropriate communication is thus a powerful tool for developing this type of self-­ regulation, as we discussed in Chapters 5–7. But for this to occur, the communication system must be available to use, the child must be able to use it independently, and its use must be reinforced. If any of these three givens are not in place, then appropriate communication is weakened. Johnston et al. (2012) referred to proficient communication as being a communicative act that the learner used independently and effectively (including using it at the right times). Thus, when an opportunity to mand for a desired event occurred, the learner was able to access that event independently. In our experience, some learners are considered to have independent communication but, in reality, are not proficient. They may need prompts from care providers to use their communication or, as just mentioned, do not have access to the materials they need to communicate. They may also “miss” opportunities to make requests because they do not recognize signals (SDs) in the environment that their communication will be reinforced (e.g., a parent has just entered the room and is available to play). Similarly, they do not recognize signals (SDs) that the parent is not available (e.g., is cooking at the stove). One key to effective FCT programs is that they do not end until the learners have demonstrated proficiency in their use of functional communication, and they appropriately generalize and conditionally use their communication skills.

Relative Efficiency of Appropriate Communication As we discussed earlier in Chapters 1 and 2, Mace and Roberts (1993) suggested that all behavior be considered a choice response. In most situations, the learner has multiple response options at his or her disposal and selects a subset of responses to produce. Thus, when there is sufficient motivation to respond, the learner will choose one response over any others. We have discussed how both strength and proficiency are related to selecting a response. A third and equally important factor is efficiency. If the appropriate communication response is as, or more efficient than, problem behavior

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to obtain reinforcement, then there is an increased probability that appropriate communication will be selected over problem behavior. Also, as discussed earlier, Horner and Day (1991) described response efficiency as consisting of three properties: (1) effort, (2) schedule of reinforcement, and (3) delay to reinforcement. These investigators showed that in order for a learner to consistently choose appropriate communication over problem behavior, the appropriate communication should require less physical effort, more reliably result in reinforcement, and access reinforcement more quickly. Richman et al. (2001) provided a good example of how effort can influence a child’s choice to appropriately communicate to receive preferred toys. The child was provided three options for obtaining toys that included aggression, handing a communication card to his mother, and signing “please.” These responses were considered as hierarchically ordered from most-to-least effortful, and during any given session, two of the responses were reinforced. The authors showed that the least effortful response (signing) was always chosen over the other two responses because it was more efficient for this child. Other researchers (Harding et al., 2001; Horner & Day, 1991; Lieving et al., 2004) have shown similar findings relative to displays of appropriate communication and problem behavior.

Consequences for Appropriate and Problem Behaviors Peck et al. (1996) showed that both the quality and the quantity of reinforcement provided for one response versus another altered the probabilities of which response was selected. These investigators provided either 1 minute of high-­quality attention or 10 seconds of low-­quality attention for two responses, and showed that a young child would select the response that provided the most and the highest-­quality attention. Gardner et al. (2009) also showed that quality of attention influenced the choices made by children who had significant behavior problems related to demands. If high-­ quality attention from an adult was paired with nonpreferred demands, the children often chose to complete the demand. As mentioned previously, children who have problem behavior maintained by attention can pose significant time pressures for their care providers. They may ask for attention repeatedly, and they may engage in problem behavior that is too severe to ignore. In these situations, Wacker et al. (2002) recommended that care providers increase both the quantity and the quality of attention provided for appropriate behavior relative to problem behavior. If the child engages in problem behavior that cannot be ignored, provide as little attention as is needed to keep everyone safe. Thus, do not look at the child, talk to the child, or touch the child any more than is

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necessary. When appropriate communication occurs, provide attention as enthusiastically as possible and include lots of physical (e.g., back rubs) and vocal attention. Make the difference in amount and quality of attention for appropriate and problem behaviors as great as possible. Several researchers have also shown that, in general, FCT works more quickly when a mild punisher is provided for problem behavior (Fisher et al., 1993; Hagopian et al., 1998; Wacker et al., 1990). For example, for an attention function, problem behavior might result in the care provider turning away from the child contingent on problem behavior. As mentioned previously, FCT can take a very long time to be effective, and the use of these mild punishers can speed up the effectiveness of FCT (Tiger et al., 2008). Mild punishers are likely to be used most often during early FCT and can assist in permitting the communicative response to be reinforced more often because the punishers more quickly suppress problem behavior than extinction.

Summary In this chapter, we have discussed problem behavior that is maintained by gaining or maintaining access to attention. We provided examples of how attention can maintain problem behavior and discussed the challenge that sometimes occurs with the lack of predictability regarding when attention-­ maintained behavior will occur. This lack of predictability may have a propensity to make it more challenging to be planful in the implementation of a behavior support strategy. Once, in a situation such as this when problem behavior occurs, care providers may have a propensity to reinforce the behavior. This is because by getting the problem behavior to stop (particularly in a public environment), the parent is negatively reinforced in that he or she gains escape from what may be a rapidly escalating and highly aversive situation. We discussed how we can also inadvertently reinforce problem behavior that we think we are punishing because of the attention we are providing contingent on the problem behavior. We also discussed the possibility of an “extinction burst” in which not reinforcing the learner’s behavior may result in intensified problem behavior for a period of time. Unfortunately, for learners with severe disabilities, the problem may be magnified by their limited repertoire of socially acceptable communicative behavior that can be reinforced should an approximation be emitted. As was the case for negative reinforcement-­maintained problem behavior discussed in Chapters 5–7, we described strategies that could enhance a learner’s acceptance of a delay in obtaining reinforcement. This chapter also summarized strategies such as NCR as a viable option in some cases. We acknowledged that with some repertoires of problem behavior aimed

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at gaining attention, it may be almost impossible not to provide some level of attention. For example, if a child is self-­injuring, it may be necessary to intervene to block the self-­injury attempts to prevent severe tissue damage. However, there is available evidence to suggest that learners can discriminate gradations of attention quality. Thus, higher-­quality attention may be able to be delivered for more desirable communicative alternatives, while necessary but lower-­quality attention can be delivered to keep the learner safe during an episode of some types of problem behavior. This discussion of quality can be offered to the learner as a choice in a concurrent-­operants paradigm (two choices are presented concurrently to the learner) in which two reinforcement options are made available with the reinforcement value more heavily weighted in the direction of the choice that may be most deliverable at the point of an impending problem behavior episode. Finally, putting the tools together is important to consider. Placing a consequence on the problem behavior with a powerful reinforcer available for the more socially acceptable alternative behavior may make it easier for the learner by making the response options more discriminable.

Chapter 9

Teaching Communicative Requests as an Alternative to Problem Behavior Maintained by Tangibles

T

here are a large number of possible positive reinforcers that represent goods (tangibles or edibles) or activities. The term tangible items is often used to refer to positive reinforcement that takes the form of goods and activities. We selected tangible items as a representative for this class of reinforcement for two reasons. Beginning with the seminal article on FCT by Carr and Durand (1985), access to tangible items such as toys and leisure materials (e.g., videos and magazines) have been commonly used in FCT programs. Second, tangible items are also often “blended” with other reinforcers. For example, Golonka et al. (2000) implemented two types of work breaks for individuals whose problem behavior was maintained by escape from demands. The first type of break condition consisted of providing a break alone (escape from the activity in which the learner had been engaging) that provided access only to negative reinforcement (no attention or activities). The second break type was described as an enriched break that provided access to preferred items, as well as negative reinforcement. The authors showed that individuals with escape-­maintained problem behavior often preferred the enriched breaks to breaks alone, and that enriched breaks are often more reinforcing. In essence, during a break, the learner gets a double dip of positive and negative reinforcement. Similar results were reported by Zarcone, Fisher, and Piazza (1996). The results of studies such as Golonka et al. (2000) suggest that FCT programs that involve negative reinforcement should include preferred tangible items and/or high-­quality attention, if possible. We recently evaluated 201

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whether young children with autism “consumed” tangible reinforcers during their breaks from demands with respect to problem behavior that was maintained by negative reinforcement (Fewell et al., 2016). This study was an extension of Wacker et al. (2011), who implemented FCT involving a two-step chain. The first step required the child to comply with a demand, and the second step taught the child to appropriately request an enriched break (a brief period away from the demand to play with toys). We wondered if the children actually engaged in play with the toys during their breaks, or if they mostly just took a break. Our results showed that most children played with toys most of the time on break. Thus, they consumed both the negative reinforcer (escape) and positive reinforcer (play with toys) while on break. We conclude from the available evidence that preferred toys can be a very important component of virtually all FCT programs, even when “tangibles” are not identified as a consequence that maintains problem behavior. If tangibles are an important component of behavior that is maintained by escape as well as tangibles, it is important to ask whether tangible reinforcers can be identified for most learners. Toy and item preferences have been the topic of frequent experimental investigations in the operant literature (e.g., DeLeon & Iwata, 1996; Fisher et al., 1992; Harding, Wacker, Berg, et al., 1999; Roane et al., 1998). In our experience, most children demonstrate strong preferences. These highly preferred items, in turn, often function as reinforcers (Fisher et al., 1992), and thus can be key components of an effective FCT program (see Chapter 3 for a discussion of preference assessment procedures).

FCT for Problem Behavior Maintained by Tangibles Unique Problems Associated with Tangible‑Maintained Problem Behavior Some learners (especially those who have an autism spectrum disorder) can display very strong preferences for specific items (see Table 9.1). These strong preferences can turn into obsessions that have the propensity to create numerous problems in implementing FCT. First, some learners appear to almost never satiate (see Chapter 5) on some preferred items. When permitted to play with the item, the learner will continue to play indefinitely. If a peer or care provider attempts to remove the item, the learner typically becomes very upset. Some learners repeatedly request an item on which they obsess when it is not available. Often in this situation, the learner appears to be very concerned about where the item is located, if it is out of sight. This concern about the item can be very disruptive—­to the point that the learner may not complete tasks or engage in other adaptive behaviors.

Requests as an Alternative to Problem Behavior Maintained by Tangibles 203 TABLE 9.1.  Concerns and Options with FCT Tangible Programs Concern

Option

Rationale

Client is “obsessed” with item and does not satiate.

•• Scheduled (NCR) access. •• Provide other preferred stimuli based on a preference assessment. •• Use a safety spot.

•• Provided only on a signaled schedule. •• Other preferred items may temporarily compete with “obsessed” item and can be used to reinforce playing. •• Learner may be willing to engage in other activities if item is “safe.”

Restricted range of actions of preferred item.

•• Scheduled access. •• Combine with “help” prompt.

•• Clear signal for when restricted actions will be permitted. •• Learner may need to request assistance to engage item.

Reinforcing under limited conditions.

•• Scheduled access. •• Combine with tolerance for delays.

•• Signals when item is available. •• Teaches learner to wait.

Limited/ unpredictable times when reinforcing.

•• Frequent preference assessments. •• Choice making

•• Identify when item is reinforcing. •• Provides options for access to the item.

Problem behaviors associated with the item can co-occur with the significant problems of self-­injury, aggression, or disruption that were shown to be maintained by tangible reinforcers in a functional analysis. A second concern is that some learners have a very restricted range of preferred actions with the item or activity. For example, a specific movie might be preferred by a learner, but closer inspection shows that only a very small segment of the movie is preferred, and the learner appears motivated to watch only that small segment. If any other segment is played, the learner can become quite disruptive very quickly. A third concern is the length of the reinforcement interval with specific items or activities. For some tangible reinforcers such as movies, the learner is reinforced only if he or she has a sufficient amount of time to watch the movie. Although very brief periods of reinforcement might be acceptable for breaks from demands or access to adult attention, watching a movie for only a minute or two might be more irritating than reinforcing. A similar concern might arise when playing electronic and board games or athletic activities. Some activities are available only in certain situations or are reinforcing only under certain conditions (e.g., playing with a peer).

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These conditions may not be present in every context (e.g., access to peers is not available immediately following every request) and thus, there is limited opportunity to use this activity as a reinforcer. All of these items and activities may be highly preferred, but function as reinforcers only under highly restricted circumstances. Conversely, some items or activities may only be highly preferred intermittently, and these times may be too idiosyncratic to be predictable. Similarly, relatively brief access to an item may result in satiation. For example, we have encountered learners who find a toy extremely preferred but only when another person is playing with it. Whenever the item is available and no other child is playing with it, the learner shows no interest.

Considerations for Teaching Appropriate Communicative Requests for Tangibles In Chapter 8, we discussed strategies for adding time-­contingent positive reinforcement into attention-­maintained FCT programs. For some learners, we can schedule sufficient access to the item/activity to reduce motivation for the item/activity. Increased access decreases the MOs (see Chapter 1) associated with the item/activity, and can sometimes reduce a learner’s “obsession” with an item. By scheduling access to the item in a highly structured and predictable manner and not permitting access to it at other times, most learners engage in other activities for slightly less preferred reinforcers during other times of the day. There are three components that can substantially improve the effectiveness of this approach to intervention. Table 9.1 depicts some common concerns and corresponding strategies that can be considered.

Conduct Frequent Preference Assessments and, When Possible, Identify Hierarchies of Reinforcers Researchers such as Roane et al. (1998) have shown that preference assessments can often be conducted within a very few minutes for many learners. These brief preference assessments (see Chapter 3) make it possible to quickly determine what is reinforcing at specific moments in time. This is important because access to less preferred but still reinforcing items/activities may make it much easier for the learner to wait to have access to the most highly preferred item. However, because they are still less preferred, the learner may not always be motivated to obtain those items (e.g., for working on a classroom task) or even be interested in having the items while waiting for the highly preferred tangible item. We have found that very brief preference assessments, such as the one recommended by Roane et al. (1998), are most useful if they are preceded

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in time by a more extensive preference assessment that identifies a hierarchy of reinforcers. Identifying a hierarchy of reinforcers initially permits the interventionist to select items that, although not the most preferred item, are sufficiently preferred and can be quickly accessed. As we discussed in Chapter 3, there are two approaches for conducting preferred assessments that result in hierarchies. These approaches are forced choice, developed by Fisher et al. (1992), and multiple stimuli without replacement (DeLeon & Iwata,1996). The former investigators showed that forced-­choice preference assessment was superior in identifying reinforcers when compared with a preference assessment that simply offered an item to the learner and recorded whether the item was taken. Forced-­ choice preference assessments (see Chapter 3) can be time-­consuming; we often conduct a forced-­choice preference assessment initially using up to 16 items. However, during subsequent sessions, we typically restrict the assessment to four items. By conducting these assessments frequently, we increase the probability that the learner has a preferred item or activity when he or she must wait for the most preferred item. Even those items that are not among the most preferred have a good probability of functioning as reinforcers when more potent reinforcers are not available. When learners react negatively to the repeated demand to choose among items, multiple stimuli without replacement (MSWO) is often helpful (DeLeon & Iwata, 1996). Recall from Chapter 3 that this assessment involves placing items in an area for the learner to access. Once the learner selects an item and has used or consumed it, he or she may select from the remaining items. Eventually, this establishes a hierarchy of preferred items.

Use a Safety Spot for the Most Preferred Item In Chapter 9 we introduced the notion of a safety spot. The following case example provides a common issue we often encounter in our FCT program (see Chapter 1) for young children with autism (Wacker et al., 2011). Ben carries his iPad everywhere and likes to replay the end of a favorite movie over and over. When requested to complete another task, such as to stack blocks or sort items by color, problem behavior occurs when Ben is asked to leave the iPad in his play area. However, if he brings it with him, it can cause problems because Ben will continue to play with it or simply because its size interferes with Ben’s ability to complete tasks at his work station. Once Ben finally starts working, he often completes the task very quickly.

Ben provides a good example of how a tangible item, even if effectively used as a reinforcer, can disrupt ongoing intervention by its presence in the work area or by the requirement to leave it behind. In most cases, after

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relatively brief training, the individual learns to put the item down, complete the demand, and then return at some later time to again have access to the item. Other learners, like Ben, respond more vehemently, and are frequently reported to be “anxious” about the item. While away from the item, the learner may constantly try to look at the item, to request the item, or leave the task to go find the item. Even when the child learns not to pick up the item while working, the learner may continue to appear to be “worried” about the item and to be disrupted by either its presence or absence. In these cases, we often use a “safety spot.” As mentioned in Chapter 7, a safety spot is a location with a salient visual cue where the item is placed while the learner engages in a required task. While on the safety spot, no one touches or takes the item. Usually, we first establish the safety spot near the work area. If the worktable is large enough, the safety spot is on one end of the table from the work area. The first step is for the learner to come to the work area, set the item down on the safety spot, complete a small amount of work, request and retrieve the item, and then go back to the play/recreational area. A timer is set for 1–2 minutes, and play/recreation continues until the timer sounds. When it sounds, a least-to-most restrictive prompting system (see Chapter 4) is used to return the item to the safety spot and the learner to the work area to complete more work. We gradually fade the presence of the safety spot by moving it back to the play area with the final step being to put the item in the designated location in the play area before going back to work. We also conduct demand fading (see Chapter 4) so that the learner is doing increasing amounts of work prior to having access to the item. We increase the delay interval by increasing work for three reasons. First, the completion of work can provide a clear visual signal that now is a good time to play. Second, the association between first working and then playing is an important one for the learner to acquire. Third, when we have used time-based signals, such as a visual timer, the learner will often simply stare at the timer and not engage in other activities. We want the learner to be productive, and so encourage working or playing rather than simply waiting. Working might actually be learning to play with other toys or activities. During “wait” times, the learner’s “job” might be to play a board game, throw a ball back and forth with a peer, or some other play activity. We usually select these activities as “jobs” because we want to expand the learner’s play skills. We select these activities initially based on the results of a preference assessment. These are the items or activities that are neutral to the learner; we select items that are neither preferred nor nonpreferred. Selecting low-­preference items could result in the learner avoiding the play situation altogether.

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We also use a safety spot when a learner must travel to a location where it would be problematic to have the item, but the child engages in severe problem behavior if asked to leave the item. We worked with a young child with autism who was “obsessed” with a large plastic shark beach toy. He was highly motivated to have this toy go everywhere with him but it was very disruptive to both him and others around him. We worked with the boy and his parents via telehealth to leave the toy on a safety spot when he arrived at a regional pediatric health care clinic. We told the child that we called it a “safety spot” because his toy was safe; no one would take it. We made the spot very large and obvious to the child; it consisted of a piece of paper that he set the toy on. We then faded the safety spot from the worktable in the exam room to the hall outside the room and finally to the car.

Develop a Very Structured, Predictable Routine with Visual Cues and Build in Choices, If Possible The identification of alternative reinforcers via preference assessments, combined with scheduled access to the most preferred items, is sufficient for most learners. Remember that the beginning of treatment should almost always require less effort from the learner, including less waiting, than what will be expected later in treatment. The fading procedures discussed previously are a critical component of most FCT programs. As discussed by Betz, Fisher, Roane, Mintz, and Owen (2013), many FCT programs require learners to tolerate delays to reinforcement. Thus, after the first training step is completed for FCT, which is most often teaching the learner to appropriately make a request (in this case, for a desired item), the next step is likely to involve teaching the learner to do more work or to wait longer before receiving reinforcement (see Chapter 4 for a more detailed explanation of this procedure). As mentioned in Chapter 8, Hanley et al. (2001) showed that fading (see Chapter 5) could be best accomplished if the learners received clear signals that their communication would be reinforced. Thus, right from the beginning of FCT, a visual signal such as word cards are always correlated with reinforcement in our programs. When the card is present, manding is reinforced immediately; when not present, manding is on extinction. By conducting training in this way, the learners learn to mand only when the card is present, and fading occurs by increasing the time between presentation of the cards. In this way, the learners learn to tolerate delays to reinforcement and thus to demonstrate self-­regulation. We cannot overemphasize the importance of signals (SDs) in FCT programs. If the learner does not know when manding will be reinforced, we

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may very well see large increases in the frequency of both manding and problem behavior at apparently random times (based on MOs). Although less problematic than a resurgence of problem behavior, high rates of manding can be very irritating to care providers and, thus, may reduce their motivation to continue the FCT program. If manding occurs at very high frequencies, it may be impossible to continue the program (Hanley et al., 2001). Of even more concern, manding is likely to encounter extinction on a frequent basis, reducing the persistence of manding in the future (Wacker et al., 2011). Remember that if manding is reduced because of extinction, or is reinforced on too lean of a schedule, problem behavior will likely show resurgence (Lattal & St. Peter Pipkin, 2009; Volkert et al., 2009; discussed in Chapters 5–7). The importance of signals when reinforcement must be delayed has long been known in behavior analysis (Lattal, 1984). Unfortunately, clear signals are not always built into FCT programs from the beginning of treatment, or are not used during maintenance to continue to guide the display of manding. If the learner either does not discriminate when mands will be reinforced (because signals were not present from the beginning of FCT) or does not continue to be guided when to mand (because the signals have been discontinued), the long-term maintenance of treatment effects may not occur and problem behavior will likely reoccur. From the very beginning of FCT, the interventionist should (1) consider what signals will be used, and (2) determine the fading plan (see Chapters 4–7 for more detailed discussions). The signals that are present at the beginning of FCT will likely continue to be needed, in some form, for a very long time. When we consult on unsuccessful FCT programs, we are frequently told that signals such as word cards and picture schedules were discontinued because they were “no longer needed” (e.g., the learner “knows” the schedule). Although a learner might continue to be successful for a least a few days or weeks following the removal of the visual signals, this may not continue indefinitely. We attempt to use signals that will become a permanent part (at least for the foreseeable future) of the learner’s environment. Thus, it is important to select signals that can be easily incorporated into the classroom, home, or work setting. When we develop a visual schedule, we consider its placement (Can it stay in that location indefinitely?), its size (Can it be easily transported?), and other features (Will it distract others?) that will affect its continued use. Once the learner has had success with FCT, then one can consider how to best promote long-term maintenance, including the fading of signals, if needed. However, it is important that one refrain from attempting to fade or alter the FCT program until several weeks or months of success have occurred. As shown by Wacker et al. (2011), FCT may need to be continued for a very long time before it can be faded, even if there are initially very good reductions in problem behavior. One approach to fading the signals, as conducted by Wacker et al. (2011), is to intermittently remove the signal

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and determine whether the learner continues to be successful. Using this strategy, the interventionist continues to probe the absence of the signal until problem behavior reoccurs. At that point, the signal is reintroduced. Conducting probes of the ongoing need for the signals (or other component of the FCT program) identifies which signals continue to be needed. Nevin and Wacker (2013) recommended that intermittent probes continue to be conducted throughout intervention, and that maintenance be defined as the persistence of positive treatment effects despite the removal of these components. Fading is conducted in two steps. The first step is to determine which signals will be permanent. Some tasks have signals that are inherently part of the task. For example, when a learner puts a puzzle together, he or she can see how many more pieces are required for it to be done. In Chapter 4, we described this as an example of an explicit delay cue. When standing in line at a fast-food restaurant, we can see how many persons are in line in front of us. Once one is first in line, reinforcement is about to be delivered. In each of these cases, the signal is permanent in that when the learner engages in the task, the signal will always be present. However, during intervention, the signal may be placed in a location to require less effort on the part of the learner prior to gaining reinforcement. For example, consider Paul, who likes to show others his completed jigsaw puzzles but often gets frustrated while solving them. Paul’s interventionist may put in the first nine pieces, leaving only one for Paul; the remaining piece is placed in front of him. Across opportunities, in the absence of problem behavior, a systematically increasing number of pieces may be placed in front of the learner. In other cases, where the signal is not inherent to the task, the interventionist must decide whether the signal needs to remain in order to provide adequate support to maintain manding in the absence of problem behavior. In this instance, the second step is to probe the need for signals that will not be permanent. Over time, as problem behavior continues to receive extinction and mands, and other adaptive behaviors are reinforced, mands will gradually become stronger than problem behavior, meaning that the mands will persist while problem behavior will continue to remain low, even when challenged by the absence of a signal. In some cases, there is a need to fade the signal itself rather than waiting for the effects of FCT to persist, even when the signal is removed. For example, the signal might be too big or cumbersome to take to other classes or the community. In these situations, we need to fade various dimensions of the signal, such as its size. Fading can occur with either permanent or temporary signals. See Chapter 3 for discussion and examples of fading. In this chapter, we have discussed both demand fading and signal fading. Demand fading occurs when the interventionist removes instructions or other task demands and then gradually reintroduces them while maintaining low or no emissions of problem behavior (Pace, Iwata, Cowdery,

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Andree, & McIntyre, 1993). Removing the task lessens the demand on the learner and lessens a propensity to escape. Demands are reintroduced in sufficiently small increments to minimize the discriminability of the incremental changes that in turn could trigger the problem behavior. Alternatively, the gradual reintroduction of demands could assist in building tolerance for the demands. Demand fading is most effective when implemented with escape extinction (Zarcone, Iwata, Smith, Mazaleski, & Lerman, 1994). Because of an immediate decrease in problem behavior, the procedure is often used successfully with learners with severe problem behavior. However, demand fading can be challenging for novice interventionists to implement. With respect to fading signals, doing so involves a technique referred to as stimulus fading. Stimulus fading involves systematically changing the appearance of an object/picture or other stimulus without decreasing the probability that the learner continues responding in the same fashion. An example of stimulus fading can be seen in Figure 9.1. The objective is to alter the appearance of the stimulus to which the learner responds without

FIGURE 9.1.  An example of stimulus fading. Adapted from Reichle, York, and Sigafoos (1991) with permission from Paul H. Brookes Publishing Co., Inc.

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interrupting the learner’s propensity to respond. An example of stimulus fading might involve a cup of coffee. Gradually, the cup is made fainter and fainter until only the word “coffee” appears. Each graded change of the darkness of the cup is made contingent on the learner continuing to respond successfully to the coffee graphic. During intervention some other graphic symbol(s) would be present as the position of the symbols would be randomized to ensure that the learner’s selection was based on symbol appearance rather than its position. Stimulus fading and demand fading are two tools that are extremely useful, in that they minimize errors and can permit intervention to proceed while quickly reducing problem behavior.

Teaching an Initial Request for a Tangible Item or Activity We start the FCT program in the same manner as described for attention in Chapter 8. We engage the learner in high-­quality play. If a preference assessment has been conducted, we have high-­preferred items during play. If a preference assessment has not been conducted, we incorporate that into play. In addition to identifying preferred items, the preference assessment will show us whether the learner tolerates the removal of the item and also the learner’s choice-­making skills. How we proceed next is dependent on the learner’s skills. We provide two examples below.

Learners with No Formal Communication Skills and/or Who Display High Rates of Problem Behavior Many of the children we work with are under 4 years of age but already display severe self-­injury, aggression, and tantrums. During play, they may occasionally play with an item but rarely stay engaged with the item. They tantrum frequently and it is often difficult to determine why they are upset. The results of functional analyses most frequently identify both escape and tangible functions. With these learners we often use either a microswitch or a word card. If a microswitch is used, it has a prerecorded message from mom or another family member that says, “Please” and “Play,” or “Mom.” If a word or picture card is used, the word or picture is printed on the card. We often begin with a generic word because it can be used in a variety of contexts involving a different tangible in which the learner might be interested. In Chapter 2, we discussed the importance of carefully considering the explicitness of selecting vocabulary items to teach a learner; it may be helpful to review that discussion prior to selecting the vocabulary specificity for learners before implementing FCT. During play, the parent (with coaching from an interventionist) will quickly remove access to a desired item and put the switch or card directly in front of the item. The child has to literally reach over the switch or card

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to touch the item. Using least-to-most restrictive prompting, the child needs to touch the card/switch and then receives the item for 1–2 minutes (signaled by a timer). The first prompt that we provide is most often a vocal prompt, which can either be specific (e.g., “Touch the card if you want to play.”) or nonspecific (“What do you do want to do?”) depending on the language skills and overall understanding of the child. The second prompt is a model prompt, which involves either a gesture (e.g., pointing at the card) or a demonstration (e.g., touching the card). Finally, if needed, we physically guide the child, as gently as possible, to make the target response. For most children, we require that they touch the card/switch independently, meaning, without physical guidance. If physical guidance is needed, then the card/ switch is represented with a vocal cue and the child needs to touch it without physical guidance. If children touch the card/switch after a vocal cue, even if they initially received a physical prompt, that is fine. They receive high-­ quality, enthusiastic attention; descriptive praise (e.g., “Yes, you asked to play!”); and the item. The card/switch is then removed (e.g., placed behind the interventionist), because the child has the item and does not need to request it. If problem behavior occurs, the item is withheld or removed until the child calms very briefly (a few seconds). At that point, the card/switch is re-­presented. High-­quality, enthusiastic attention is given each time the child communicates independently and appropriately, even if long periods of problem behavior had occurred prior to communication. Initially, the wait time is as close to zero as possible, and then is very brief (a few seconds), signaled with a timer and/or visual cues (e.g., parent counting fingers). An alternative approach we have used involves no verbal cue because we have found it somewhat difficult for parents to fade. Instead, we have used physical prompts that we fade very quickly. When the learner does not mind physical prompting, we have used it to establish the desired response prior to the emission of problem behavior so that we can begin a history of reinforcement right after touching the symbol. In doing this, it is important to quickly fade the assistance to avoid the learner treating the prompt as part of a response chain. Some suggest that this is how “leading” (not fading physical prompts quickly enough) in children with autism spectrum disorder may get started. In general, least-to-most hierarchies can work well with persons with little intervention experience because they can memorize a chain to implement and essentially, learners, by their actions, tell them when to stop prompting. With skilled interventionists it may be possible to obtain quicker acquisition with a rapidly faded most-to-least prompting sequence. If the child rapidly changes items, and wants to do something different (e.g., take a walk, look out a window, have a snack), we require that he or she first communicates before receiving that item. We do not expect the learner to generalize right away, and so we continue to train the child how

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to communicate to receive desired items or activities. Generalization is frequently facilitated because we are using two strategies: (1) sufficient exemplars, and (2) common stimuli (items or materials that are common across settings). As discussed by Stokes and Baer (1977), there are several strategies that can be incorporated into training programs that increase the probability that generalization will occur. Each of these strategies is addressed in general case instruction, and provides a specific procedure to be used to promote generalization across settings, people, tasks, or activities. “Sufficient examples” involves training multiple examples, such as requesting multiple items, in multiple settings, and with multiple people. We continue training new examples until the learner independently communicates for a new item, in a new setting and/or with a new person. As Durand and Carr (1991) showed, generalization across people will happen only if the communicative response is understood by the new person. This is why it is important to carefully consider what the communicative response will be and how others will react to it. If others do not understand, and do not reinforce the communicative response, the learner may stop using the response (i.e., maintenance fails to occur), and problem behavior may reoccur. A second procedure for promoting generalization is to use “common stimuli.” If, for example, the word card is always given to the learner when the learner can have an item, then the learner may generalize the communication response for requesting novel items, novel settings, or with novel people. In our projects, we always incorporate sufficient examples and/or common stimuli into the FCT programs. Having a generic message makes the generalized use of a mand easier (because the message does not change), but we can also change the message as the child changes items or activities. For example, if the child walks away from the toys and toward the window, the switch is held by the parent between the child and the window. The child must communicate independently to be raised in front of the window. After 30–60 seconds, the child is lowered down and the card/switch repositioned in front of him or her. If the child displays problem behavior, the card/switch is removed until he or she is calm, and least-to-most restrictive prompting is provided. Each time the child appears to want an item or activity, this same sequence is followed. At other times of the day, the parent continues to use general case procedures, as discussed in the previous chapter. For example, the parent insists that the child always emits appropriate communication prior to receiving a desired item to teach the child to first communicate and then to receive what he or she wants. When this is not possible, the parent will not reinforce problem behavior but may just provide a desired item or activity when he or she observes that the child wants something. The parent never provides access to the switch/card unless he or she is prepared to reinforce appropriate communication.

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Some children are very quick to respond to this program and seem to enjoy the two-step process of waiting and then requesting. Other children resist this program and refuse to independently touch the switch or card. Even very young children may resist touching the card or switch independently. Some children will immediately let us guide them to touch the card/ switch, but others resist the physical prompts. Either way, we make the child communicate independently before he or she can have access to the item. Thus, as mentioned previously, if we have had to physically guide the response, we then ask the learner to do it independently (e.g., “OK, now you touch the switch”). Access to the preferred item/activity occurs only following an independent request. The long-term success of FCT is dependent on the child being able to make requests independently. As we have discussed earlier in this book, FCT permits the learner to respond to changing MOs (states of deprivation and satiation). Learners can control their access to items, activities, and people by requesting more or less of something. Therefore, FCT represents a really powerful tool for self-­regulation but only if the learner communicates independently. This is why, from the very beginning of FCT, we try to set the occasion for the learner to communicate independently as quickly as possible. We frequently use augmentative or alternative communication systems—­even when the learner is capable of vocally communicating—­because we can better prompt these responses and can often make communication independent more quickly than with vocal communication. However, when using FCT we almost always accept all forms of appropriate communication. For example, if the child says, “Truck” rather than “Please,” we give him or her a truck. Some care providers will actually provide more reinforcement for vocally communicating than for gestural communication. Recall Bobby from Chapter 8, who was almost a permanent fixture on his mother’s hip. When he first said, “Ma” rather than signing “please,” he received very enthusiastic and very long hugs because his mother highly valued him speaking. She continued to reinforce signing but provided higher-­quality and longer amounts of attention for speaking. Sure enough, and as was previously shown by Peck et al. (1996), Bobby soon began to talk vocally more than to sign, probably because talking produced a higher quality and quantity of attention. Peck et al. (1996) also showed that the children selected the communication option that resulted in the highest quality and quantity of attention, and that this was the case even when the options included problem behavior. One reason Bobby began to say “Ma” is because his mother always said this word when praising his signing. When he signed “please,” his mother always said, “Mom,” and hugged him. She later changed this program, with guidance from a behavior analyst, to say “Play” or the names of items (e.g., “Truck”). Once again, Bobby received a more enthusiastic response

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for play requests than only for attention, and after a few months had gained a lot of play skills (see Derby et al., 1997, for a description). If Bobby had continued to receive attention for problem behavior, then it would have been even more critical that appropriate communication receive a much higher quality and quantity of reinforcement than problem behavior received. Otherwise, we would expect that problem behavior would have continued to occur even after the appropriate communication had been learned. Thus, it is not simply the learning of a new, more appropriate communication response that leads to the reduction of problem behavior. As discussed by Mace and Roberts (1993), the display of one response over another is a choice, and the learner will tend to make those choices that are more functional. A more functional response is one that is efficient for the learner to emit, is effective in obtaining reinforcement, and is under good stimulus control, meaning that there are signals regarding when it will be reinforced. When FCT programs are first implemented, appropriate communication often produces enthusiastically delivered reinforcement that is given immediately. In contrast, problem behavior is ignored or produces punishment such as time out. If maintenance fails to occur, the first step is to determine if the quality and quantity of reinforcement have been altered, such that problem behavior now more efficiently produces greater intensities and amounts of reinforcement. These types of fidelity errors are common in positive reinforcement programs, and are especially common in programs requiring care provider attention. From the very beginning of treatment, identify the goal of treatment and conduct demand or schedule fading until desired levels of working or waiting are achieved, and until communication is under the control of known signals.

Learners with More Conventional Socially Acceptable Communication Skills Who Show Intermittent Problem Behavior Some learners have highly proficient communication skills, but sometimes fail to use those skills prior to producing severe problem behavior. A functional analysis can be difficult to complete with some learners because of how infrequently problem behavior occurs. For these individuals, we begin FCT by conducting a preference assessment, but most often use the procedures described by Northup, George, Jones, Broussard, and Vollmer (1996). These procedures are conducted vocally; the learner makes vocal choices of preferred items and activities. The next step is to go through the learner’s schedule and to offer as many choices as possible. Thus, if homework needs to be completed during an evening, the learner can choose what assignments are completed first. The learner also selects the preferred activity that occurs following

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the completion of homework. We ask families to conduct these “planning” sessions at least weekly and, if possible, daily. We refer to this program as “calendar time” because the learner and parents complete their schedules on a weekly calendar that is posted for everyone to see. All children and family members have their own schedules, and complete their schedules during a family meeting. Conflict for these learners appears to occur most frequently when the learner wants access to an item or activity but access is denied. The calendar time program can function as a signal, letting the learner know when access will occur. It is critical that the calendar function just like every other signal. Access to desired items or activities occurs only when scheduled. Some or all of these scheduled times can be time based rather than contingent on completing s task prior to advancing in the schedule (but should always be delivered contingently based on a particular time—that is, the learner cannot have access at any other time other than when it is scheduled). A second component of FCT that we build into these programs is frequently going over each scheduled activity and working on the correct mand for the learner to use with care providers. As described in Chapter 2, when working on nonpreferred tasks, the learner may want more frequent breaks, longer breaks, assistance, or to avoid the activity altogether. At the family meeting, the preferred outcome is discussed as is the best way for the learner to make the request. Thus, we use the family meeting to help the learner to discriminate what to request, how best to request, and what the consequence will be, based on a general case instructional approach to intervention. This is then written on a schedule or calendar.

Summary In the preceding chapters, we often referred to tangible items because highly preferred items can be used to enrich breaks or to compete with attention. Thus, FCT tangible programs are frequently a part of every FCT program. In this chapter, we described some unique concerns that can occur with tangible items and offered suggestions for addressing those concerns. We then described how we adjusted FCT based on the skills of the learner. As discussed previously, there is no one FCT program; there are many different components within every FCT program. Similarly, the way each component is implemented will vary based on many variables, including the skills of the learner. However, despite these variations, the end goal remains constant across every FCT program: The learner replaces problem behavior with independently emitted appropriate communication to obtain desired social reinforcers.

Chapter 10

Describing Functional Communication Training as a Component of an Effective Behavior Support Plan What We Know and What We Still Need to Know

The Importance of Addressing Problem Behavior Consistently, Comprehensively, and Early Consistently addressing the needs of individuals who engage in problem behavior has been cited as a critical area of need by parents, educators, and health care providers; this need is even more obvious among those who serve persons with severe and multiple developmental disabilities who tend to have a higher prevalence of problem behavior (Harvey, Boer, Meyer, & Evans, 2009; National Institutes of Health, 1989). Overall, epidemiological estimates suggest that approximately 15–20% of individuals with intellectual and developmental disabilities exhibit problem behavior (Emerson, 2003; Lowe et al., 2007). Among young children, establishing strategies to limit and prevent problem behavior is challenging given that most children, regardless of their disability status, engage in some problem behavior (likely due, at least in part, to emerging self-­regulatory skills paired with a limited conventional communicative repertoire). For example, Patterson (1986) reported that approximately half of interactions among 2-year-olds involved problem behavior. The good news is that, for most children, problem behavior subsides as a result of maturation and contingencies available in the natural environment. The less positive news is that, for some children, problem behavior has a propensity to become more pervasive. For this latter group, an intervention that results in a rapid decrease in problem behavior 217

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during the preschool years is vitally important. We know that failing to do so can result in persistent problem behavior that has been associated with a greater risk for lower educational achievement (Campbell, 2002, 2006). We also know that without effective intervention, problem behaviors contribute to poor physical and mental health; worsened educational, social, familial, and residential outcomes; and decreased community participation (Brown, MacAdam-­Crisp, Wang, & Iarocci, 2006; Malick-­Seltzer & Krauss, 2001; Mugno, Ruta, D’Arrigo, & Mazzone, 2007; Werner et al., 2009). We also know that persons producing problem behavior may receive less positive attention from others and the attention that they receive may be more directive and reprimanding in nature (Carr, Taylor, & Robinson, 1991; Fry, 1983; Reichle, 1990). With respect to living in the community, persons with substantial problem behavior tend to live in more restricted residences and have more limited community opportunities. These variables, in turn, can place considerable stress on all of the involved stakeholders (O’Neill, Vaughn, & Dunlap, 1998; Sinclair, Christenson, Evelo, & Hurley, 1998). Much of the variability in the degree to which normal aspects of life are impacted negatively can be accounted for by the presence or absence of problem behavior in the course of daily routines (Hastings, 2002; Malick-­Seltzer & Krauss, 2001; Mugno et al., 2007). We frequently hear health care professionals tell parents that their child will “outgrow” problem behavior. Although it is true that maturation and the accompanying advances in self-­regulatory and social communicative skills can result in significantly diminished problem behavior, there are subgroups of children who do not outgrow problem behavior. For these children and their families, the more time that goes by without developing a systematic plan of action, the greater the stakes become because the stronger (more resistant to treatment) problem behavior becomes as it continues to produce reinforcement for the child.

The Importance of Determining What Maintains Problem Behavior Determining variables that maintain problem behavior through the implementation of a functional behavior assessment encompasses a wide range of procedures, all of which are aimed at determining the “reasons” or maintaining variables that continue to reinforce learners for producing problem behavior. Numerous studies have demonstrated the efficacy of various functional behavioral assessment procedures when the assessment outcome is well matched with relevant intervention procedures (e.g., Carr & Carlson, 1993; Carr et al., 2002; Durand, 1990; Iwata et al., 1982; Iwata, Dorsey, et al., 1994; Kemp & Carr, 1995; Mace, Lalli, & Lalli, 1991; Pelios et al., 1999; and numerous others).

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The gold-­standard component of a functional behavior assessment is a functional analysis (see Chapter 6). There have been numerous demonstrations of the efficacy of manipulating antecedents and/or consequences in an experimental design to identify the social functions associated with problem behavior (e.g., Carr et al., 1976, 1980; Carr & Durand, 1985; Iwata et al., 1982; Iwata, Dorsey, et al., 1994). Functional analyses are distinguished from the other components of a functional assessment because they allow for a determination of causal relationships between problem behavior and the circumstances that influence its maintenance over time. Interviews and descriptive (ABC) assessments, on the other hand, often provide useful information but can only suggest possible (correlative) relationships between the problem behavior and any maintaining variables. Typically, an interview followed by an ABC assessment (Bijou et al., 1968) procedure represents a starting point. In the interview and the ABC assessment, a parent or practitioner carefully records the form of the problem behavior and the events that occurred prior to and immediately following a problem behavior episode, along with interviewing those familiar with the learner. These recordings are then summarized to look for patterns of antecedents and consequences that appear to be associated with the problem behavior. In practice, if the results from an ABC assessment and interview are clear, we initiate intervention(s). We often conduct a functional analysis in settings such as schools or homes only when less intense assessment or commonsense intervention strategies are unsuccessful.

Assessing Motivating Operations Movivating operations (MOs) refer to the variables that alter the momentary value of a reinforcer (see Chapter 1). They are the psychological, emotional, physiological, social, or environmental conditions, past or present, that influence the likelihood that problem behavior will occur because of its relationship to those variables. As a field, we are not very good at assessing MOs. This is particularly the case for MOs that are not immediately observable (e.g., those events that are less proximal to a discriminative stimulus associated with problem behavior). Longitudinal observational data used to examine correlations between antecedents, behaviors, and consequences can be done, but may not be practically used by interventionists serving persons in natural environments, and is often beyond the typical educators’ resources and capability. However, investigators have reported on the assessment of currently available MOs (see Miltenberger, 1998) and developing assessment strategies for MOs represents an important area of translational research.

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Once a potential MO has been identified, it may be possible to establish a structured descriptive analysis to examine the presence versus absence of the variable on occurrences of problem behavior. Unfortunately, this strategy cannot always be used, as some MOs cannot be objectively observed. For example, pain cannot always be observed. A learner may not reliably consume medication and there may be no observable events that can be observed to confirm medication status. States of deprivation and satiation that serve as MOs vary widely across individuals (Wacker et al., 2008), and so there cannot be one level of attention, breaks from demands, or play that are sufficient across all learners. Complicating the evaluation of MOs is that often there are frequent and sometimes substantial changes in MOs. Thus, they often can be identified only via the communication of the individual (e.g., when a break is needed because of increasing fatigue). Increasingly, interventions based on MOs have been shown to be a critical component of reinforcement-­based and positive behavior support programs (see Bambara & Kern, 2005). When combined with a communi‑ cative alternative (see Chapter 2) they can be particularly effective because learners can regulate states of deprivation and satiation via their functional communication (Wacker et al., 1990). Learning more about how to accurately pinpoint MOs associated with socially maintained problem behavior represents an important area for researchers to rigorously explore, and especially with individuals who are not yet independent communicators.

Linking Assessment to Intervention Carr and Durand (1985) were among the first to clearly demonstrate the importance of directly linking information gleaned through a functional assessment with the pragmatic function of the communicative act chosen for intervention. They showed that by selecting a communicative alternative that served the same social function as problem behavior (i.e., escape, obtain or maintain access to goods and services, and obtain attention), they were able to teach the alternative and at the same time obtain collateral decreases in problem behavior (see Doss & Reichle, 1989; Durand, 1990; Durand & Carr, 1987, 1991). Alternatively, selection of a communicative alternative that served a nonmatching social function was taught, but did not result in a corresponding decrease of problem behavior. Thus, as addressed in Chapter 1, communicative alternatives to problem behavior require functional equivalence between the new alternative and the problem behavior. Without determining the variables that motivate and maintain problem behavior, any intervention is, at best, a guess at what is needed.

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Although necessary, identifying one of the major socially mediated variables that maintains a particular problem behavior may not be sufficient to result in a direct linkage to intervention. For example, as we pointed out in Chapter 2, determining that a behavior serves an escape function may be only the first step toward informing the interventionist’s choice of a functionally equivalent communicative alternative. Tasks that from the learner’s perspective go on too long may require teaching a “break request.” For activities that are beyond the learner’s ability to complete independently, an “assistance request” may be the best alternative. For tasks that are highly aversive, a “No, thank you” request may be needed. Although in all instances just described, the function of behavior is escape, the communicative alternative must be more narrowly pinpointed to effectively treat problem behavior. This requires an understanding of MOs as well as response–­reinforcer relations. Once a learner’s problem behavior has been matched to a functionally equivalent and socially acceptable behavior, an interventionist can design and implement a variety of relevant interventions.

The Necessary Components of a Behavior Support Plan As Reichle and Moore (2015) summarized, ultimately, a behavior support plan must address four primary areas: 1. Designing proactive interventions/strategies to develop/facilitate conditions that minimize problem behavior and set the occasion for positive behavior. 2. Teaching socially acceptable behaviors that replace problem behavior (the primary focus of this book). Doing this may also require modifying instructional delivery or events that may alter the learner’s acceptance of instruction or social interaction. 3. Reinforcing positive/socially desirable behavior. 4. Arranging for the absence of reinforcing consequences (or outcomes) for problem behavior so the behavior becomes inefficient and ineffective for the person. A comprehensive plan with specific, individualized components in the preceding areas serves as a set of systematic guidelines for the actions of others who interact with the learner (Carr et al., 1994; Durand, 1990; Reichle et al., 1996). Each of the areas just described must be applied at an individualized level with the intensity required to establish progress toward the person’s goals.

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The Form of the Communicative Alternative Taught Winborn et al. (2002) evaluated the effects of teaching novel and existing mands (see Chapter 1) during FCT with two 2-year-old children who experienced developmental delays. Existing mands were those that were already part of the learners’ existing communicative repertoire. Novel mands were those with which the learners had no prior experience. They reported that when reinforcement for either request was concurrently available, the children used existing request forms more than novel requests. This suggested that existing forms likely required less effort to produce and as a result were more efficient. However, the existing requests were more apt to be associated with the emission of problem behavior when compared with the probability of problem behavior being associated with a novel form. In the case of existing communicative forms, problem behavior may have had a history of being associated with the existing behavior. For example, the learners may have engaged in problem behavior. This, in turn, may have received a parental prompt of “Use your nice words.” In this case, a chain of behavior in which problem behavior may have been associated with a more desirable communicative alternative could have been established. Alternatively, the learners may have come to use the desirable communicative alternative. If, however, the parent did not respond within efficiency boundaries established by the learner, the child may have followed the socially acceptable behavior with problem behavior that may have been more likely to be immediately reinforced by the parent. Other studies (Mace et al., 2010) have shown that mands and problem behavior can be so closely associated that reinforcing either one of these behaviors also strengthens the other. Studies such as those by Winborn et al. (2002) speak to the importance of selecting target behaviors but also speak to the importance of considering sequencing relationships established between problem behavior and the communicative alternative being taught. To date, there is a very small evidentiary base in the applied FCT literature addressing this area.

Maintaining Newly Established Functional Communication A relatively small number of investigations have examined longer-­term maintenance of communicative alternatives to problem behavior. For example, Durand and Carr (1991) demonstrated that FCT intervention gains could be maintained across 2 years (likely due to the careful consideration of natural maintaining contingencies in implementing intervention). Hetzroni and Roth (2003) reported that reductions in problem behavior remained steady during follow-­up sessions that continued for several months subsequent to intervention. Nevin and Wacker (2013) suggested

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that maintenance be viewed less categorically (it occurred or did not occur) and more functionally (under what conditions the benefits of treatment continued to occur). For example, Wacker et al. (2011) showed that the beneficial effects of intervention continued to occur during brief periods of extinction only after many months of treatment. In order for maintenance to occur, FCT had to be conducted for a very long time, even after problem behavior occurred at zero or near-zero levels. In their classic article on stimulus generalization, Stokes and Baer (1977) discussed the importance of addressing natural maintaining contingencies for newly established behavior. For example, in the environments where the learner is expected to use the newly established behavior, it is important to determine whether reinforcers will be naturally available without making special arrangements. Given the preceding discussion of how long treatment will need to continue in some cases, it is important that reinforcers routinely be available to reinforce occurrences of communicative alternative behavior. It is also important to determine what that schedule of reinforcement is likely to be as a comparison with the (likely, denser) schedule of reinforcement that was available during acquisition (e.g., Fisher et al., 2000; Hanley et al., 2001). If the discrepancy is great, intervention must be implemented to (1) systematically thin reinforcement to approximate that available in natural environments, or (2) increase the density of reinforcement in natural environments, or (3) teach the learner to accept delays to reinforcement, or (4) all three. Without sufficient reinforcement for emissions of newly taught behavior, it will not be likely to maintain, and even brief periods of extinction may produce the resurgence of problem behavior. In addressing the failure to maintain newly taught alternatives to problem behavior and the reemergence of problem behavior, investigators have begun using the term resurgence (see Chapters 1 and 2 for a more complete discussion of this topic; see also Lattal & Wacker, 2015). A discussion of resurgence is useful in framing maintenance issues associated with communicative alternatives to problem behavior (Volkert et al., 2009; Wacker et al., 2011). With resurgence there may or may not be significantly diminished use of socially acceptable alternatives to problem behavior. For example, a learner may continue to engage in the newly taught communicative behavior, but quickly follow it with the original problem behavior when reinforcement is not sufficient for just the emission of a socially acceptable communicative alternative. If not sufficient, the learner may resort to the production of his or her original repertoire of problem behavior or establish a chain that is reinforced. In the study by Volkert et al. (2009), each participant engaged in self-­injury, aggression, or disruption that was maintained by either negative reinforcement (escape from demands), positive reinforcement (access to attention and tangibles), or both positive and negative

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reinforcement. After being taught to request using a socially acceptable communicative behavior, an extinction condition was implemented for 10 sessions during which the functional reinforcer was no longer provided for either problem behavior or the alternative communicative response. Problem behavior reoccurred for four of five participants. This outcome also occurred when the schedule of reinforcement was thinned. The relatively high probability for recurrence of problem behavior without adequate reinforcement represents a critical concern in settings where maintaining reinforcing contingencies are not always available on an adequate schedule or are delivered highly inconsistently. Researchers including Fisher et al. (2000) and Hanley et al. (2001) have shown that learners can tolerate delays to reinforcement (see Chapter 4) and/or thinned schedules of reinforcement (see Chapter 6), but the schedule will likely be learner specific. For example, maintenance may be variable depending on a host of MOs in the environment, and will best be individualized for each learner with whom one is intervening rather than looking for a generalized decision rule that can be applied across learners. Resurgence is particularly concerning when one considers that some communicative alternatives must be used conditionally (e.g., one can politely reject an offer of a beverage rather than scream, but one cannot reject the offer of seizure control medication). To date, too little is known about how to produce long-term maintenance; it is an area that is underemphasized in the literature.

Generalizing Newly Established FCT A number of investigations (Berg et al., 2007; Durand, 1999; Durand & Carr, 1991; O’Neill & Sweetland-­Baker, 2001; Schindler & Horner, 2005; Wacker et al., 2005) have addressed the generalization (see Chapter 3) of participants’ performance. As we discussed in earlier chapters, Drasgow et al. (1998) taught learners to use a conventional communicative request in a classroom setting. Generalization probes implemented in the home suggested that generalization did not occur subsequent to acquisition. It appears that in the children’s homes, the behavior that was the focus of replacement at school continued to be reinforced. Thus, at home, problem behavior resulted in the desired outcome so there was no reason to use a different form. Rather than implementing the entire teaching procedure at home, they instead placed an extinction contingency on the problem behavior that was occurring at home. Two of the three learners almost immediately began using the more conventional communicative symbol at home. Results of the preceding study have implications for how we view generalization, in general. We believe that there may be instances of a bias to view generalization as a cognitive limitation. For example, we might view the

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lack of generalization as being a routine part of the learner’s intellectual disability. Instead, as with maintenance, we need to be less categorical and more functional. We need to identify the conditions under which generalization occurs. For example, it is possible that learners may “realize” that they can use a newly established alternative behavior, but choose not to switch to a new alternative because that response had not been sufficiently strengthened or reinforced. The Drasgow et al. (1998) study speaks to the topic of conditional use of behavioral repertoires that involve differential responding as a result of conditions in the environment.

Identifying the Possible Interaction between Generalization and Conditional Use The bulk of FCT interventions have treated generalization as a phenomenon that occurs subsequent to acquisition. In Chapter 3, we discussed general case instructional strategy as an instructional format that is designed to ensure that a sufficient range of teaching examples (sufficient exemplars) has been implemented to help ensure well-­generalized, yet well-­ discriminated (common stimuli) use of communicative acts. In general case instruction, the interventionist carefully identifies a range of situations that call for the production of the communicative behavior being taught (positive teaching examples). Alternatively, the interventionist identifies situations that call for the learner to refrain from using the targeted communication behavior (negative teaching examples). A sufficient range of positive and negative teaching examples should maximize the discriminative use of the new skill, while at the same time maximizing desired generalization. Thus, a general case instructional format emphasizes both appropriate and inappropriate generalization. In teaching a communicative alternative to problem behavior, one often hopes that a learner will use his or her newly established skill in moderation. Learning to use a skill in moderation raises some challenges for an interventionist. One consequence of emitting assistance requests is obtaining assistance (models or other prompts related to how to engage in the activity associated with the request). During quality instruction, the assistance that the learner receives should include the delivery of efficient prompts to engage in the behavior that the learner needs to acquire to perform the task that was associated with the assistance request. Across opportunities, the interventionist should be able to fade the prompts, allowing the learner to increasingly become more independent in engaging in the task (and the interventionist to fade the prompts that were delivered as a consequence of the learner’s request). As this happens, the need for the learner to request assistance should be reduced or eliminated. The result is

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that the environmental conditions that once served as the discriminative stimulus for an assistance request may eventually become a discriminative stimulus for independent work. Currently, very little work has been done to examine this area.

Considering Multicomponent Intervention and Behavior Support Strategies If one considers the importance of conditional use (see Chapter 3), it becomes somewhat obvious that more than a single intervention strategy being concurrently implemented will be necessary to address problem behavior. In this section, we consider the blending of behavior support strategies. If one selects a single social function maintained by problem behavior such as escape, it is reasonable to assume that some of the activities from which one wishes to escape may be “escapable,” contingent on the production of a more desirable communicative alternative. At the same time, other activities from which the individual may want to escape may not be “escapable” (e.g., taking seizure control medication). Given this set of circumstances, it seems plausible that with many persons, a concurrent implementation of two or more different intervention strategies may be warranted to address each social function associated with problem behavior. In spite of this likelihood, there are relatively limited experimental reports of the concurrent implementation of procedures to simultaneously address problem behavior. A number of authors have provided detailed discussions addressing a wide range of strategies that can be combined in a positive behavior support package to address both when the function of problem behavior can be reinforced and other contexts in which it cannot be reinforced (see Bambara & Kern, 2005, and Chapter 4 of this book). Despite the compelling logic for the concurrent implementation of interventions to improve self-­regulation (see Chapter 3) and socially acceptable alternative responses, this remains an important area in need of additional research to establish an evidence base. Of critical importance in further examining the effect of concurrently implemented strategies is the importance of evaluating the under- and overgeneralization of multiple strategies within a behavior support package. For example, Falcomata et al. (2013) showed that both appropriate and inappropriate generalization of mands can occur across functional contexts. This study was one of the first to evaluate the effects of teaching multiple mands (in this case, signs) within the same program. These types of evaluations are needed to guide clinicians and teachers who implement FCT programs with learners who have no or very minimal formal communication.

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Addressing the Range of Collateral Gains Emanating from Successful FCT Teaching functional communication skills may result in collateral gains that were not the original primary focus of an intervention procedure (e.g., affect improvement, longer on-task behavior, improved academic performance, improved problem behavior that was not specifically targeted for intervention, greater levels of social initiation and engagement, and/or an increase of peer play; see Braithwaite & Richdale, 2000; Derby et al., 1997; Frea, Arnold, & Vittimberga, 2001; Hetzroni & Roth, 2003; Lalli et al., 1995; Schieltz et al., 2011). For example, Derby et al. (1997) examined both short- and long-term effects of FCT on problem behavior, target requests, and collateral behaviors. Results demonstrated that with each of four participants, positive social behavior (both the first occurrence of and ongoing social and toy play behaviors) emerged while effective suppression of problem behavior was achieved. Frea et al. (2001) found that peer play increased following the implementation of a communicative alternative to problem behavior. Braithwaite and Richdale (2000) reported that subsequent to successful FCT intervention, their participant was more inclined to persevere with tasks. Others have reported improved production of spoken language occurred with learners who were verbally imitative at the outset of communication intervention, as well as gains in comprehension of spoken language (e.g., Hetzroni & Roth, 2003; Harris & Reichle, 2004; Mirenda, 1997; Yoder & Layton, 1988; see also Millar, 2009). Despite these reports, there is somewhat limited information on the mediating and moderating variables associated with these gains. Future researchers may wish to explore these variables to better determine pivotal skills that may be associated with these gains. Doing so could have significant implications for identifying complementary skills to teach along with FCT.

Addressing Social Validity, Treatment Fidelity, and Contextual Fit Several areas for future research include social validity, procedural reliability or treatment fidelity, and contextual fit. Wolf (1978) described the importance of evaluating the social significance of the goals of an intervention program, the appropriateness of the program’s procedures, and whether the program implemented is of social importance as a result of its effects. Traditionally, interventionists have thought of these as critical in considering social validity. Winett, Moore, and Anderson (1991) sought to broaden the boundaries of social validity and delineated measures and procedures to assess it. These authors described a socially valid intervention as one that is “directed to a problem of verifiable importance, in which

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intervention is valued and used appropriately by designated target groups and has sufficient behavioral impact to reduce substantially the probability of the problem’s occurrence among the target group” (p. 216). Schwartz and Baer (1991) broadened social validity to include a stakeholder’s satisfaction with an intervention and the feasibility of carrying out the treat‑ ment. This latter addition highlighted contextual fit as an important aspect of a socially valid intervention. To a great extent, the social validity of behavioral interventions has been investigated through the use of questionnaires or informal observation (Machalicek, O’Reilly, Beretvas, Sigafoos, & Lancioni, 2007). Lucyshyn, Horner, Dunlap, Albin, and Ben (2002) emphasized the importance of working with families while delivering intervention in the context of important family activities as one strategy to enhance contextual fit. These investigators implemented a family assessment of settings, values, and beliefs to inform intervention prior to actually implementing an intervention. Carr et al. (1976) proposed that contextual fit required that intervention procedures be consistent with the values, skills, resources, and administrative support of those who must implement the plan. Horner, Blitz, and Ross (2014) defined contextual fit as “The match between the strategies, procedures, or elements of an intervention and the values, needs, skills, and resources available in a setting” (p. 1). These authors provided a summary of elements of contextual fit along with some practical considerations in evaluating the contextual fit of intervention strategies. Among the considerations that they offered were (1) whether the outcomes of the intervention are highly valued, (2) whether current success was low enough to justify an alternative, (3) whether the prospective intervention clearly describes the intervention including specification of the interventionists as well as when and why the intervention will be implemented, (4) a clear description of the intervention procedures, (5) a description of intervention recipients and settings in which the result of the intervention will occur, (6) a justification that the effort and commitment required to implement the intervention is reasonable, and (7) that the proposed intervention is apt to be more efficient than current interventions. They concluded that the elements of contextual fit have relevance for designing, choosing, implementing, and modifying interventions to enable them to be sustained. For the most part, contextual fit has received increasing attention in the FCT evidence base. We suspect that in many schools, intervention strategies frequently may not have a high degree of contextual fit among the interventionists implementing them. A common comment made by paraprofessionals when asked what they are implementing is that “They just do what they are assigned.” Often when asked the logic supporting what they are implementing, they tell us they really are not sure. We suspect that there is a relationship between the degree of contextual fit

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that is established among implementers of instructional programs and the implementation/treatment fidelity with which a program is implemented. Schindler and Horner (2005) described an approach for enhancing the contextual fit of intervention strategies. They implemented FCT with three 4- to 5-year-old children with autism using high-­effort intervention in one primary setting and two secondary settings with low-­effort intervention. High- and low-­effort interventions shared the equivalent controlling antecedents and consequences but varied in their implementation intensity. Results revealed that low-­effort intervention in the secondary settings was not effective when implemented alone. However, after the implementation of a high-­effort intervention in the primary setting, the reintroduction of low-­effort intervention in secondary settings brought about the desired reduction of problem behavior. The investigators provided parents and teachers/assistants with a 6-point Likert-­like scale to assess their perceived effort to implement and the feasibility of FCT under high- and low-­effort intervention conditions. With higher contextual fit reported for the low-­ effort condition, this study highlights the importance of designing interventions based not just on the evidence supporting an intervention but also on contextual fit variables that may affect whether an intervention will be implemented with fidelity in an applied context, and generalized by interventionists to other untaught situations. This study suggests that learning about contextual fit may assist interventionists in matching intervention sophistication to multiple interventionists, and that enhancing contextual fit may require a sequenced implementation strategy.

Implementing Interventions with Fidelity The overwhelming majority of studies implementing FCT outcomes report relatively high observer agreement (i.e., how well two or more independent observers can record the dependent measure). This makes sense in that the majority of studies utilized single-­case designs that have internal validity and precise behavioral definitions as highly valued components of the research methodology. Alternatively, with procedural fidelity/treatment integrity it is a bit of a different story. Chen (2011) reviewed FCT investigations implemented since 1985 with learners with severe developmental disabilities. That review found that a small number of investigations conducted procedural fidelity checks. Of course, unless one can consistently implement the intervention plan as it was designed, it is less likely that the learner will benefit from the intervention. Failure to report data addressing treatment fidelity may have significant implications for translational research in applied settings. For example, both Volkert et al. (2009) and St. Peter-­Pipkin et al. (2010) showed that degraded implementation fidelity

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resulted in resurgence of problem behavior. St. Peter-­Pipkin et al. (2010) further showed that the type of fidelity error mattered relative to decays in treatment effectiveness: Commission errors (incorrect responses) were more problematic than were omission errors. Suess et al. (2014) conducted a retrospective evaluation of implementation fidelity among parents of three children with autism spectrum disorders. Each parent implemented FCT in his or her home. All training was provided to the parents via telehealth by a behavior consultant during weekly 1-hour visits. Fidelity levels were evaluated via videotaped samples during coached and independent trials by recording parents’ omission and commission errors. Although, overall, some errors (e.g., omission errors associated with reinforcing manding) occurred more frequently, none of the errors appeared to have a strong relationship with treatment outcomes. All children showed substantial reductions in problem behavior. The findings of good fidelity and good treatment outcomes may have occurred because of the long-term coaching provided by a highly skilled applied behavior analyst. As discussed previously, long-term success in treatment may require longer periods of time in treatment. However, as shown by St. Peter Pipkin et al. (2010), this will be effective only if commission integrity errors are prevented or corrected. The potential importance of coaching and its relationship to fidelity is supported by an investigation by Johnson et al. (2009), who examined the fidelity with which intervention strategies were implemented by educators in preschool environments to address the needs of children engaging in problem behavior with and without coaching. They reported that educators in their control group (no coaching) exhibited 38% fidelity while implementing positive behavior support strategies. A treatment group that had received longitudinal mentoring and on-site technical assistance exhibited 80% fidelity. These data suggest that obtaining treatment fidelity may represent an important activity not only for researchers but practitioners as well. In school settings, there is often no coaching or practice prior to the expectation that a new procedure designed by a behavior analyst or other professional will be implemented. Establishing fidelity is further complicated by the often multiple interventionists implementing a new intervention protocol. Varied levels of fidelity across interventionists could directly influence intervention outcomes, with respect to quality of treatment dosage (intensity) that is required for behavior change. One viable area for future applied research exploration may involve examining the degree to which implementation fidelity can be degraded while still achieving an acceptable level of intervention outcome. Currently, we know relatively little about implementation fidelity in naturalistic environments. Fidelity in natural environments may be far lower than in the evidence-­ based demonstrations that comprise

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the available literature. Because fidelity data are rarely obtained in many natural environments (e.g., schools), the quality of intervention implementation is often presumed suspect. Is it a lack of contextual fit? Alternatively, is it because many evidence-­based procedures were not developed in educational or home settings and the interventionists were highly trained research assistants rather than practitioners? Is it because the contextual variables surrounding the intervention were different? Thus, in some contexts fidelity may be high, but in other contexts, much lower (e.g., some educational activities may have a much denser student-­to-­teacher ratio than other activities). If this is a pervasive feature in educational service delivery, it is important to find out why and to develop solutions to improve implementation fidelity.

Coordinating “High‑Dose” and “Low‑Dose” Interventions Many interventionists in naturalistic settings will not have had extensive training in the implementation of the interventions that are needed to address the needs of persons who engage in problem behavior. Consequently, interventions designed to maintain and generalize new behavior will have to be as straightforward as possible. It is likely that the rigor used to establish a behavior may not need to be as great to maintain or generalize the behavior for many learners, especially if maintenance is based on empirical demonstrations of persistence of alternative behavior during challenges to treatment rather than based on time in treatment. However, there is a paucity of evidence-­based literature in this area. One particularly good application of combining high- and low-dose interventions may be in implementing a framework of general case instruction. This framework for intervention—­discussed in Chapter 3 and subsequently in additional chapters—­ requires rigor. It will sometimes require that different intervention strategies be conducted to address positive and negative teaching exemplars, which in turn represent distinct challenges to the effects of treatment. There may be some merit in initially establishing intervention effects in situations where interventionists implement treatment with high fidelity and have the time to concurrently consider both positive and negative teaching examples. Once conditional use of the new behavior is established, the program can be extended to interventionists who may be apt to implement with lower fidelity, and/or who need more signals to guide their implementation of the intervention. Although not as optimal as implementing general case instruction across a greater range of contexts, this strategy may still result in good long-term outcomes. To date there has been little systematic work completed in this area.

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Validating Instructional Procedures in Translational Settings Although information addressing the environments where interventions were implemented and the persons who served as the interventionists can be somewhat spotty in the existing literature, many of the current evidence-­ based intervention strategies have not been extensively implemented in natural settings where the behavior is to be maintained. For example, a substantial number of FCT strategies that have experimental validation have relied on the implementation of instructional protocols during one-to-one instruction with researchers as the interventionists in highly controlled settings. Wacker et al. (2013) demonstrated that FCT can be implemented by care providers when they received telehealth coaching from trained applied behavior analysts. The parents of young children with autism who displayed problem behavior traveled to regional outpatient clinics. Each clinic had a designated outpatient room for telehealth consultations with behavior analysts located a number of miles away. The parents and their children were coached by the behavior analysts to conduct functional analyses to identify the reason why problem behavior was occurring and then begin FCT. Parents served as implementers for every assessment and FCT session; the behavior analysts never had physical contact with the parents or children. The parents achieved substantial reductions of problem behavior. Follow-­up studies (Lindgren et al., 2016) show that similar results can be obtained when telehealth is implemented directly in the home. We believe that the delivery of FCT treatment via telehealth can be implemented in most settings, even those that are not highly controlled or that do not have highly trained staff at the outset of coaching activities.

Identifying the Levels at Which Support Tactics to Prevent and Reduce Problem Behavior Are Implemented: In the End, It Takes a Village In this book, we have primarily addressed intervention and support strategies that have been individualized to meet the needs of specific learners. However, effective intervention can occur at a variety of instructional levels (Hanley et al., 2007). Optimally, a systemwide framework of supporting environments to prevent and address existing instances of problem behavior must include high-­quality preventative measures applied to all individuals in a tiered system. There are numerous examples of schoolwide behavior support initiatives that have developed a three-­tiered implementation framework.

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1 involves proactive social methods for the systematic delivery of more consistent and dense schedules of positive reinforcement for desired social behavior paired with consistent consequences and support strategies directed at problem behavior for all students. „„Tier 2 implements behavior support strategies with individuals who will need some additional intervention that does not require a detailed and highly individualized plan. For example, weekly social skills groups for students who require support for initiating and maintaining friendships. „„Tier 3 focuses on individuals who require highly individualized supports (this group has been the primary focus of this book). „„Tier

Within recent years, the integration of behavior support strategies in schools has been within the greater context of response to intervention (RTI). Like school­wide behavior support, RTI offers a framework that embraces incremental levels of support with a goal of preventing a learner from needing more intensive individualized instruction. RTI has steadily gained popularity in the academic community, and its consistency in approach to that of schoolwide behavior support has been discussed in a number of publications (Bambara & Kern, 2005; Bayat, Mindes, & Covitt, 2010; Crosland & Dunlap, 2012; Kern, Gallagher, Starosta, Hickman, & George, 2006; Noltemeyer & Sansosti, 2012). Recent schoolwide behavior support initiatives (Fallon, McCarthy, & Sanetti, 2014; Goh & Bambara, 2012; Kelm & McIntosh, 2012; McIntosh, Filter, Bennett, Ryan, & Sugai, 2010; Solomon, Klein, Hintze, Cressey, & Peller, 2012; Sugai, O’Keeffe, & Fallon, 2012; Vincent & Tobin, 2011) have yielded a framework of proactive social objectives that utilize the systematic delivery of more consistent and dense schedules of positive reinforcement for desired social behavior paired with consistent consequences for problem behavior for all learners. Procedures used at all intervention tiers of a schoolwide model of behavior support include any combination of strategies that involve reinforcement contingencies, new curricula/activity schedule, promotion of self-­regulatory skills, enhancement of personnel skills, modification of instructional delivery, FCT, and a host of antecedent-­focused strategies (e.g., tolerance for delay of reinforcement, choice making, and numerous others; Carr et al., 1994; Durand, 1990; Facon, Beghin, & Rivière, 2007; Fenerty & Tiger, 2010; Hong et al., 2015; Johnston et al., 2012; Reichle et al., 1996, 2010; Sellers et al., 2013; Sparks & Cote, 2012). Despite our successes in behavior support (particularly at tiers 1 and 3 of the model), there remain a number of areas that require a greater evidence base in improving our technology in addressing the needs of individuals who either engage in, or have a propensity to engage in, problem behavior.

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Summary Improving the application of empirically supported interventions in addressing problem behaviors is an unquestioned research and service delivery priority (Hemmeter, Fox, Jack, Broyles, & Doubet, 2007). In this chapter, we have outlined a number of areas that we believe require additional attention from the applied research community and also from those who provide preservice and inservice preparation for professionals. Despite what may seem to be overwhelming needs, it is equally important to attend to the impressive changes in the approaches and procedures that have emerged during the past 20 years. We now have a well-­documented technology of assessment and intervention strategies to address the needs of most learners who engage in problem behavior that is maintained as the result of socially mediated consequences. We have approaches for developing school­wide support systems for learners who engage in problem behavior. Although we face challenges in improving evidence-­based instructional technology, perhaps our greatest need is to increase the application of the instructional technologies that we have in the environments where behavior will be maintained. Much of what has been discussed in this book is not being deployed in as many applied settings that would benefit large numbers of learners. Currently, the reasons for this are many and have not been very systematically addressed. Thus, one of the greatest current applied needs is to address the implementation of what we already know how to do. The field of communication intervention for persons who experience problem behavior has made spectacular advances in the past several decades. Stakeholders should revel in these accomplishments. However, we need to continue advancing our knowledge, and to do this most effectively, we endorse the need for more translational research (Mace et al., 2010). In this book, we have used the issues surrounding maintenance of treatment gains as our case in point for basing new knowledge on translational research. Translational studies of behavioral momentum theory have contributed to our understanding of how to promote durable changes in behavior; they represent a novel approach for understanding why maintenance often fails to occur, and for developing innovative approaches to improving maintenance. Throughout this book, we have tried to integrate translational studies with applied studies to provide a stronger understanding of why behaviors are occurring, recurring, or failing to occur. To better understand behavior, we need to identify the behavioral mechanisms that underlie the behavior, such as the specific MOs that make escaping a task reinforcing. Understanding the basic mechanisms that underlie behavior permits us to better promote durable changes in alternative communicative

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behavior. It also reduces the probability that problem behavior will reoccur. However, once we have conducted these studies, applied studies are needed to determine how best to implement the procedures we have developed through the translational studies. Again, using maintenance as our example, we need to determine how to implement procedures with sufficient fidelity so that they can be used in the settings where behavior will be maintained. We have learned a great deal since Carr and Durand (1985) provided their classic article on FCT, but we should not lose sight of the ongoing need to better understand why behavior is occurring and how to better maintain the behavior we have taught through FCT.

Glossary

ABC analysis.  Analysis of the antecedents and consequences surrounding an operationally defined behavior. In an ABC analysis, an observer records each instance of a problem behavior along with relevant antecedent events that preceded the behavior and relevant consequences that followed the behavior. After accumulating these data, the interventionist summarizes patterns of relationships between antecedents and problem behavior, and the behavior and consequences that follow the behavior. Abolishing operation.  A type of motivating operation; an event or stimulus that decreases the value of a reinforce, resulting in a decrement in behavior associated with that reinforce. For example, drinking 36 ounces of a beverage decreases the value of the beverage as a reinforcer for most people and suppresses beverage-­seeking behavior. Activity-­based schedule.  A prespecified sequence of activities for which the learner must participate for a nonspecified period of time prior to advancing to the next event depicted in the sequence. Some interventionists allow much more flexibility in individualizing the length of an activity. Giving a learner control over the duration of an activity may make it easier to focus on creating salient opportunities in teaching him or her to follow visual cues without being distracted by the amount of time needed to engage in the activity. Adherence.  Following a recommended course of intervention for the length of time prescribed by a professional. For a more comprehensive list of terms used in applied behavior analysis, see Cooper, Heron, and Hewsard (2007); for translational and basic behavior analysis, see Catania (1998).

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Antecedent-­focused intervention strategies.  Strategies in which the goal is to implement an intervention(s) in activities or other stimuli that have been demonstrated to be associated with problem behavior before the learner engages in problem behavior. Antecedent-­based interventions, such as alterations in motivating operations, modify an aspect of the (1) setting, (2) activity, (3) materials used in the activity, or (4) actions of the interventionist. Antecedent manipulation.  Systematic manipulation of an antecedent event hypothesized to be related to a problem behavior. Behavior regulation.  Behaviors that regulate momentary states of deprivation and satiation. In FCT, it most often refers to a communicative act that is produced to regulate the behavior of another person to obtain a specific outcome. Specific examples under this category include requests for an object/action and to protest object/action. Behavioral momentum.  Refers to the relationship between a behavior’s persistence and its rate of reinforcement within a specific context. In applied behavior analysis, studies based on behavioral momentum theory have been used to evaluate the resurgence of problem behavior following successful periods of treatment when the effects of treatment are challenged (e.g., via extinction). Block(ing).  A physical intervention procedure that interrupts problem behavior. For example, John attempts to hit Sam’s face. Sam raises his forearm to interrupt the hit so that John’s arm is unable to make contact with his face. Building rapport.  A connection marked by community of interests or similarity in nature or character. In the context of beginning communication, initial steps toward establishing rapport may involve simple activities such as establishing an individual as an entity to be approached (behaviorally establishing an individual as a reinforcer). Chain of behavior.  Several behaviors are produced in a sequential order and a reinforcer occurs after the emission of the last behavior. Each behavior in the chain acts as a discriminative stimulus or cue for the next behavior. For example, when one hears the bread pop up in the toaster, it is a discriminative stimulus to reach for a knife to put butter on the toast. Communicative alternatives.  A socially acceptable communicative form that is maintained by the same events as a particular problem behavior. For example, if a learner cries to obtain treats but could also obtain treats by raising his or her hand, we can say that crying and raising a hand are functionally equivalent responses with respect to treat procurement. In this example, raising a hand represents an alternative to crying. Communicative functions.  The specific reason that is associated with a person’s communicative production. Although communicative functions overlap with behavioral functions on a more general level, they often are more specific examples of behavioral functions. For example, a request for assistance can

Glossary 239 be maintained by escape but can also be effective in obtaining access to a tangible. Within the behavioral function of negative reinforcement, examples of communicative functions include: (1) request assistance, (2) request a break, and (3) protest. Communicative intents.  Production of a communicative act designed to influence the behavior of another individual (an illocutionary act). Communicative means.  The mode (form) used to produce a communicative act. For example, an individual can produce spoken words, natural gestures and/or signs, or graphic means such as photographs, pictures, or printed words. Community shopping list.  A graphic organizational aid that includes a list of items to be purchased on a shopping trip. Competing schedule of reinforcement.  Occurs when a different reinforcement schedule is assigned to each of two different behaviors. Typically in intervention programs one behavior will have a more dense schedule (e.g., communicative alternative) and a behavior that one would prefer to decrease would be assigned a leaner schedule of reinforcement (e.g., idiosyncratic or problem behavior). Concurrent-­operants preference assessment.  At least two response or response options are available to an individual. Each response is associated with an independent schedule of reinforcement or different reinforcing outcome, and the individual can chose which of the two responses to emit to obtain the associated reinforce. Evaluating the individuals choices over trials or time can identify the relative value of each reinforcer. Conditional discrimination.  Occurs when the learner is choosing how to respond in an activity that requires differentiation based on the presence of a particular stimulus (e.g., in matching-­to-­sample one must select a choice that corresponds to the sample provided). Conditional-­discrimination procedures involve four-term contingencies, in that a stimulus is arranged to enable the determination by the learner of which three-term contingency will operate (e.g., in the presence of a real apple, the learner selects an apple from a choice array that includes apple, orange, and pear; however, in the presence of an orange, the learner will select an orange from the same array). Conditional use.  A conditional discrimination that requires differentiation between situations that require separate behaviors. For example, in FCT, in different situations, the learner can either use a communicative request or refrain from using a communicative request (such as a break). Consequence manipulation.  Systematic manipulation of the consequences that are hypothesized to maintain problem behavior (e.g., If escape is hypothesized to be maintaining a problem behavior, providing the learner to escape right after the behavior could be compared to a separate condition in which escape is not offered).

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Constant time delay prompting.  There two types of time delay procedures: (1) progressive and (2) constant. During a progressive time delay, an interventionist gradually increases the waiting time between an instruction and any more intrusive prompts that might be used to obtain a response from a learner. During the implementation of a constant time delay, the natural instructional cue and the prompt that predictably results in a response are paired. Across successful opportunities, a fixed amount of time is always used between the instruction and the prompt as the learner becomes more proficient at using the new skill. Continuous schedules of reinforcement.  Each correct response results in the delivery of a reinforcer. Control function.  Within FCT, this most often refers to the learner having independent functional communication, permitting the individual to respond to momentary changes in states of deprivation and satiation. Independent functional communication training thus provides the individual with increased control in regulating his or her behavior. Controlling prompt.  Consistently results in the emission of the target behavior but does not allow the learner to operate independently and must eventually be eliminated (e.g., each time a learner has an opportunity to put his clothes away, his mother must point at the clothes hamper). Critical event.  A term used in conjunction with the implementation of tolerance for delay in the delivery of reinforcement. When a learner engages in problem behavior to escape an activity, there is a range of engagement prior to the problem behavior. The critical event is the interval of engagement immediately prior to the problem behavior. At the end of this interval, the interventionist releases the learner from the task or prompts a mand for release. For example, during baseline, Mark engages in a durative task for 30s, 45s, 90s, and 30s prior to problem behavior. His team selects 25s as the initial critical period of engagement to maximize the probability of initial success. At the end of 25s, Mark is released. Delay signal.  A graphic, gestural, or spoken event, or other stimulus that cues the learner that contingent on limited continued appropriate behavior (waiting or engagement depending on the task), he or she will be reinforced. A delay signal represents an integral component of a tolerance for delay in the delivery of reinforcement procedure. Delayed reinforcement.  The duration of time between the occurrence of target behavior and the delivery of reinforcement. It is a specified length of time prior to the delivery of reinforcement for a behavior specified for reinforcement. Demand fading.  In this strategy, task demands are reduced initially in order to increase the probability of task engagement without the emission of problem behavior so as to increase the probability of the learner receiving

Glossary 241 reinforcement. Subsequently, demands are gradually and systematically increased to the level that they were during baseline. Deprivation.  The withholding or absence of a reinforcer for a period of time. Deprivation is a motivating operation that increases the saliency or value of the reinforcer. Differential reinforcement.  The reinforcement of one behavioral form or members of one response class with no reinforcement delivered for a different form of behavior. In FCT, differential reinforcement most commonly occurs when the communicative alternative produces reinforcement and problem behavior is placed on extinction. Discrimination (discriminate).  Discrimination in FCT can refer to either a simple or conditional discrimination. Conditional discrimination.  See “Conditional discrimination.” Simple discrimination.  See “Simple discrimination.” Discriminative stimuli.  A stimulus or event in the presence of which a response is reinforced and when absent the response is not reinforced. Once this stimulus is discriminated by the learner following multiple pairings with reinforcement, it then signals the learner that if a particular response is produced in the presence of or immediately after the SD that response will be reinforced. Embedding.  Placing a task that has a low probability of engagement between two tasks that have a high probability of engagement (variation of the Premack principle). Enriched break.  A break within which the learner is allowed to both briefly escape a task and also have access to positive reinforcers such as preferred items for a specified amount of time. Environmental manipulation.  Systematic manipulation, usually of one variable at a time (antecedent or consequence, singular response class such at attention or escape) in order to identify the functional relation between a target (e.g., challenging) behavior and some specific aspect of the environment (e.g., class of reinforcement). Functional analysis procedures are an example of an environmental manipulation. Error correction.  A response prompt that is delivered after the learner has produced an incorrect response or no response. Errorless instruction.  A teaching strategy in which the stimulus prompts are arranged to produce changes in behavior in small incremental steps to minimize errors. Escape extinction.  Occurs in behaviors that are maintained by negative reinforcement when a target behavior that has historically produced escape (e.g., from a nonpreferred task) no longer is reinforced. After an individual produces

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Glossary

a problem behavior that is maintained by escape, the learner’s escape is prohibited. Explicit delay signal.  A delay signal (See also “Delay signal”) that specifies an exact length of engagement or number of task items that must be completed prior to the delivery of a release signal (e.g., “only two more to go”). Extinction.  Discontinuing reinforcement for a behavior that has been reinforced (positively or negatively) in the past. Extinction burst.  The escalation of target behavior, such as problem behavior, that occurs when reinforcement for that behavior is withdrawn. Extinction often produces a temporary increase in the frequency and vehemence of the target behavior prior to a sloping decline in behavior emissions. Fade.  The gradual and systematic removal of a prompt. Typically, a change from one level of prompting to a lesser level is contingent on learner successful responses. False negative.  Occurs when there is an indication that a condition or event is not present when in fact it really is present. For example, in functional analyses, a false negative occurs when attention fails to be indentified as maintaining problem behavior when in fact it is a reinforcer of problem behavior. Fidelity.  Intervention/treatment fidelity (also referred to as integrity) refers to the accuracy with which procedures implemented adhere to a prespecified agreed-­ upon protocol. Fixed or variable time schedules.  In a fixed time schedule, the interval between reinforcement delivery is constant (e.g., a reinforcer is delivered once every minute). In a variable time schedule, the interval varies within a specified range of times. Function.  The maintaining variable for a behavior. Problem behavior may be maintained by social consequences that include gaining access to or maintaining access to goods and services, activities, and attention, or to escape or avoid persons, goods, activities, or attention that is or has become aversive. Nonsocial reasons for the emission of problem behavior may include biological reasons (e.g., ear infection) or problem behaviors that are self-­reinforcing to the learner. Functional analysis.  A systematic approach to conducting a functional behavior assessment within which the antecedents and consequences surrounding a problem behavior are manipulated independently so that their effects on the challenging behavior can be measured and observed. Functional communication training.  A systematic intervention approach implemented to teach a socially acceptable alternative to problem behavior that is emitted to gain access to reinforcers or escape or avoid aversive events. FCT

Glossary 243 is always implemented after the social function(s) of an interfering behavior(s) has/have been identified and is a specific example of differential reinforcement. Functional equivalence.  When changes in the contingencies controlled by one pair of stimuli are sufficient to change the learner’s behavior with respect to other pairs (see Sidman, Wynne, Maguire, & Barnes 1989, p. 272). Functional equivalence refers to different topographies of behavior being maintained by the same reinforce or reinforcement class. For example, if crying results in obtaining a cookie but saying “Cookie, please” also results in obtaining a cookie, the two responses are said to be functionally equivalent responses. General case logic.  A systematic framework for selecting teaching examples that represents a continuum of stimulus variations and response requirements in a criterion setting. The range of examples includes the stimulus situation under which the target behavior both should occur and should not occur. General delay signal.  A delay signal that does not precisely specify the duration or quantity of engagement (e.g., “Hang on”; “We’ve almost got it made”). General delay signals can comprise one component of a tolerance for delay in the delivery of reinforcement instructional strategy. General and explicit vocabulary.  A reference to members of a continuum of word/symbol specificity. Some communicative symbols represent a large stimulus class of items (e.g., fruit = apples, banana, pear, orange). Other symbols represent a narrower class of items (e.g., apple). The specificity of the stimulus class for a given symbol within a symbol system can vary along a continuum of specificity. Any given symbol can then be described based on its specificity. Generalization.  Emission of a target behavior in stimulus conditions not directly experienced during acquisition. In FCT, generalization occurs when the learner emits the appropriate communication alternative in a setting, with a person, or within a task or activity that is different than where, with whom, or with what he or she was originally trained. Generalization probe.  The measurement of a target behavior in a stimulus condition such as a setting that is different from the one in which training was provided. Graphic organizational aids.  Using printed words, pictures, photographs, or product logos to depict a schedule of events that are either within an activity or across a sequence of activities. Habituation.  Repeated exposure to a stimulus that results in a decrease in learner responsiveness. Hierarchy of reinforcers.  The order of preference for a number of reinforcers. The hierarchy of reinforcers is determined through a preference assessment. Implementation fidelity.  See “Fidelity.”

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Instructional control.  The relationship between a learner and interventionist for which there is a very high probability that the learner will respond appropriately to a cue or instruction delivered by the interventionist. Joint attention.  Joint attention acts include receptive (responsive) or productive (initiated) acts. Productive joint attention.  The user’s gaze or gaze and gesture directs a partner’s attention to an environmental object or event. Receptive joint attention; An individual follows the direction of a communicative partner’s gaze or related gestural behavior. Magnitude of the response prompt.  The force or intensity required to have a learner respond correctly. A hierarchy of least to most prompt strategies is often used. Maintenance.  The continued occurrence of a newly acquired behavior in the absence of intervention over time, or the persistence of treatment effects when treatment is challenged via, for example, problems with fidelity. Mands.  An act that is controlled by states of deprivation and satiation (including exposure to aversive stimuli). In the communication literature requests for goods, services, and attention, along with protests, are referred to in the applied behavior analysis literature as mands. Modeling.  The production of a target behavior that serves as an instructional prompt for the learner to replicate. Most-to-least sequence of prompt delivery.  Arranging prompts during the early phases of instruction to increase the probability of a learner’s response approximation. Across successful applications, the interventionist systematically lessens the intrusiveness/intensity of the prompt until it has been removed. Most commonly, the order of prompts is arranged from physical guidance to modeling or gestural prompts to vocal or signed prompts. Motivating operations.  Condition(s) that either increase or decrease a reinforcer’s or punisher’s effectiveness. A motivating operation results in a temporary change in motivation or perceived value of a reinforcer and an increase in all responses that historically have resulted in the delivery of that reinforcer. Multielement designs.  The relative effects of two independent variables are compared by presenting each of those variables within a random or counterbalanced arrangement and evaluating their effects on behavior. In the intervention literature, this design is sometimes referred to as alternating-­treatment designs and is used in order to ascertain the comparative effect of two treatments. Two treatments are alternated in rapid succession and correlated changes in target behavior are plotted on a graph to facilitate comparison. Mutual gaze.  Eye contact between two people.

Glossary 245 Natural prompt.  Prompts associated with the emission of a behavior that occur in the environment. For example, a telephone ring is a cue to pick up the phone. A natural prompt does not need to be faded because it is used on a regular basis by typical peers. This is sometimes referred to as a permanent prompt because there is no attempt or need to remove or fade it. Negative reinforcement.  The removal of an aversive event that is contingent on a learner-­produced behavior. For example, suppose that a learner says “no” to the offer of corn (a disliked food) and it is removed. If this response-­ consequence history continues, the word “no” continues to be produced because it is negatively reinforced. Negative teaching examples.  Identifying a set of events that sample the range of stimulus features when the learner should refrain from emitting a target skill being taught (e.g., not requesting a beverage in a location that prohibits drinking). Noncontingent reinforcement.  Consequences that have maintained problem behavior are delivered on a prespecified schedule (also called time-­contingent) regardless of the learner’s actions. Providing the reinforcement on a prespecified schedule reduces the individual’s motivation to produce problem behavior by altering states of deprivation or satiation independent of the behavior. Because it is delivered on a prespecified schedule, it also places problem behavior on extinction, thus weakening the behavior by disrupting the response–­ reinforcer relation. Observer agreement.  The degree to which two or more individuals record the same event at the same time. IOA serves as a measure of the reliability of a recording system. Overgeneralization.  The extension of a response to a set of stimulus conditions that are not intended to be associated with the response. For example, if a child consistently labels a dog with the spoken word “Cat,” the word cat is described as being overgeneralized. Positive teaching examples.  Identifying a set of events and/or situations that sample the range of stimulus features that should result in a behavior being produced. Preference assessment procedure.  A systematically implemented procedure to determine items and events that a learner finds desirable that may function as reinforcers. Some preference assessments result in only identifying the relative preference of specific items or activities, whereas others establish a hierarchy of preferred items. Premack principle.  Following a low-­probability behavior with a high-­probability behavior increases the probability of the low-­probability behavior’s future emission.

246

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Procedural fidelity/treatment integrity.  The degree to which an intervention or intervention package is implemented as intended. Prompt fading.  Gradually diminishing a level of providing guidance to a response approximation by delaying its presentation, reducing the magnitude of the assistance, or changing the location of the assistance. Protodeclaratives.  A vocal and or motor act directed to a communicative partner that is intended to direct the partner’s attention to an object or event in the immediate environment. Punishment.  A consequence following a specified response that serves to decrease the probability of the response occurring in the future. Range of positive teaching examples.  Identifying a spectrum of activities and/or situations that represent opportunities to produce a target behavior. A subset of these is selected that represents the range of important stimulus features to use during the implementation of intervention procedures. Reinforcer assessment.  An assessment (sometimes implemented following a preference assessment) to determine which objects, events, and/or persons serve as reinforcers for specific behaviors. For example, once a preference assessment has identified that two items are relatively more preferred than other items, the interventionist might determine if the learner will independently request either item or will complete a task to obtain the item. Release signal.  A graphic, gestural, or spoken event that indicates the criterion specified in the delay signal has been met. The learner may then access reinforcement. A delay signal and a release signal are critical components of a tolerance for delay in the delivery of reinforcement procedure. Representational specificity.  The explicitness of a symbol that is chosen for instruction. Specificity influences the level of context that must be present or inference that must be made in deciphering the meaning and/or social function of a communicative act. Response chain.  Two or more responses that occur sequentially. Reinforcement after the last response in the sequence of responses reinforces not just the behavior occurring immediately prior to reinforcement but rather the entire sequence of behaviors. Response class.  Behaviors that may vary in topography but are maintained by the same class of reinforcement. In FCT, problem behavior and alternative communication serve the same function, meaning they are maintained by the same class of reinforcement. When this occurs, we say that they are members of the same response class. Response cost.  A punishment procedure that involves the removal of a reinforcer contingent on the production of a behavior that is targeted for deceleration.

Glossary 247 Response prompt.  Producing a targeted response through the use of assistance, frequently in the form of verbal instruction, gesture, model of target behavior, graphic representation, or partial physical to total physical guidance. Response shaping.  Reinforcing successively closer approximations of a target behavior. Resurgence.  Recurrence of a response that was originally reinforced and subsequently successfully extinguished. SD s.  An event that occurs prior to a particular response that does not signal an opportunity to obtain reinforcement. Satiation.  Reduction in the effectiveness of a reinforcer as a result of repeated exposure or consumption. Schedule of reinforcement.  The schedule that determines the conditions under which a learner will be reinforced. A learner may be on a continuous schedule of reinforcement (e.g., reinforced every time a correct response is produced). A learner may be reinforced on a variable or fixed interval or ratio schedule (e.g., reinforced either at fixed or varying schedules determined by time or number of correct responses). A learner may be on noncontingent schedules that are based on time rather than behavior. Other schedule arrangements specify response requirements (e.g., progressive ratio schedule) or the alteration of consequences under specific stimulus conditions (e.g., multiple schedule). Self-­regulation.  The capacity to alter one’s behaviors to address standards, ideals, or goals based on the expectations of the social community in which one operates (Baumeister, Vohs, & Tice, 2007). In FCT, it is the acquisition of independent communication that permits the learner to respond to momentary states of deprivation or satiation. Setting event.  A physiological, social, or environmental condition, past or present, that enhances the salience of an antecedent event that is associated with problem behavior. Simple discrimination.  Occurs when there is different responding in the presence of two or more stimuli. For example, if when offered a candy bar and a beverage, the learner always selects a beverage, a simple discrimination has occurred. Prior to responding, the learner need only attend to the choice array and need not look for a particular external cue to determine how to respond. Social function.  The emission of behavior(s) to influence the environment (most often the behavior of others) in order to procure or maintain access to attention, to procure or maintain access to goods or services, or to avoid or escape an event that is (or has become) aversive. Relative to problem behavior, social functions refer to the environmental reinforcers that maintain its occurrence. Social interaction.  A class of communicative acts that is produced to attract or maintain another’s attention to oneself, or to continue or to discontinue a

248

Glossary

specific behavior. For example, a child’s goal may be to get an adult to look at or notice him or her. Stimulus control.  Producing a specified behavior or members of a response class in the presence of a given stimulus but not in its absence because of the historic relation of the behavior to reinforcement when the stimulus is present. Tact.  Production of a communicative act that can be reinforced by a range of nonspecific social reinforcement (e.g., If a child sees a cat and says “Cat,” the reinforcer could be the parents’ excited reaction to the child naming the cat). Tangible item.  Material goods or activities. Task demands.  Actual tasks that are required of a learner. Tasks that are perceived as difficult by the learner may prompt problem behavior if problem behavior is maintained by negative reinforcement. Time-based schedule.  A schedule in which the transition from one activity to another is time dependent. The learner is taught to follow an activity sequence of the schedule regardless of the time spent in each activity depicted on the schedule (e.g., move on to reading following 50 minutes of math, whether or not you finished with the math). Time-­contingent reinforcement.  See “Noncontingent reinforcement.” Time delay.  A prompt-­fading strategy in which the latency between the discriminative stimulus and the delivery of a controlling prompt is increased in either a constant or progressive manner. Time out.  A brief suspension of a learner’s engagement with an object/activity or attention contingent on the emission of a specified class of problem behavior. It is designed to remove opportunities for reinforcement as a contingency for problem behavior. To-do list.  A form of a graphic organizational aid that comprises a list of “chores” activities that the learner needs to complete. Tolerance for delay in the delivery of reinforcement.  The learner accepts delays to the delivery of escape, attention, or tangible reinforcement that has historically maintained problem behavior (sometimes referred to as signaled delay or signaled reinforcement; see Reichle, Johnson, Monn, & Harris, 2010).

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Index

Note. “f,” “n,” or “t” following a page number indicates a figure, a note, or a table. Page numbers in bold refer to entries in the Glossary. ABC assessment, 122, 219, 237 Abolishing operation, 237 Access to goods or services, behavior maintained by. See also Reinforcers; Tangible items; Tangible-maintained problem behavior functional communication training and, 202–216, 203t, 210f overview, 201–202, 216 tolerance for delay in the delivery of reinforcement (TFD) procedure and, 60–61 Across-activity schedules, 64–65. See also Schedules Across-prompt-type fading strategy, 82, 83t. See also Prompt fading Activity-based schedules, 65–67, 237. See also Schedules Adherence to intervention, 33, 237 Aggression, 62–63 Alternatives, communicative. See Communicative alternatives Antecedent analysis, 56. See also Tolerance for delay in the delivery of reinforcement (TFD) procedure Antecedent manipulation, 132, 238 Antecedent-focused intervention. See also Demand fading; Graphic organizational aids; Intervention strategies; Prespecifying a competing schedule of reinforcement; Prompt fading; Signaled reinforcement to address undesired generalization, 53–54 definition, 238 examples of, 35, 36, 46–47

implementation and, 46–47, 47–50, 49f overview, 33–36, 51–52, 53t, 91, 233 reinforcement and, 42 setting-event interventions, 84–91, 84f, 85f, 87f, 88f Applied behavioral analysis, 15, 17–18, 40–41 Appropriateness of using communicative alternatives. See also Communicative alternatives communicative protest and, 94 overview, 28–29 Assessment. See also Preference assessment linking to intervention, 220–221 maintenance of problem behaviors and, 218–219 motivating operations (MOs) and, 219–220 self-regulation and, 31 Assistance, requesting. See Requesting assistance Attention during play, 155t Attention-maintained behavior. See also Problem behavior developmental processes and, 181 functional communication training and, 181–196, 183t, 185t, 191t overview, 179–180, 199–200 tangible-maintained problem behavior and, 215 tolerance for delay in the delivery of reinforcement (TFD) procedure and, 60–61 use of appropriate communication and, 196–198 Avoidance-motivated problem behavior, 101–102

267

268 Backward chain, 238 Behavior regulation, 16–17, 16t, 238. See also Communicative function Behavior support plan, 221 Behavior support strategies, 226. See also Intervention strategies Behavioral momentum theory, 238 Behavioral problems. See Problem behavior Blocking of problem behavior, 192, 238 Break, requesting. See Requesting a break Brief preference assessments, 204. See also Preference assessment Building rapport, 89–91, 238 Chain of behavior (response chain) definition, 238, 246 overview, 5–6 setting events and, 86 teaching communicative protesting and, 106 Choice attention-maintained behavior and, 188–189, 193 reinforcement and, 119, 120 requesting a break and, 159–160 schedules and, 68–80, 70f, 72f tangible-maintained problem behavior and, 203–204, 203t, 205, 207–211, 210f Choice responding, 188–189. See also Choice Cognitive/emotional setting event, 84f. See also Setting event Communication behavior, 2–8, 3t, 7t Communicative alternatives. See also Intervention strategies assessment and, 220 definition, 238 examples of, 36, 37, 46–47 generalization and, 224–226 implementing a comprehensive behavior support program and, 48–49 integrative implementation and, 46–47 maintenance of, 222–224 overgeneralized use of, 53–54 overview, 2, 28–30, 179–180, 222 problem behavior and, 36–39 reinforcement and, 42 requesting and returning from a break and, 160, 167–169 requesting assistance and, 128–129, 135, 136t tolerance for delay in the delivery of reinforcement (TFD) procedure and, 59–60 Communicative function, 14–15, 238–239. See also Behavior regulation; Functions of a behavior; Joint attention; Social interaction Communicative intents. See also Intentionality definition, 239 functional assessment and, 19–20 overview, 13–14, 14–15

Index social functions of problem behavior and, 17–20 symbol specificity and, 22–23 Communicative means definition, 239 overview, 13–14 selection of alternative communicative behaviors and, 23–27, 25t teaching communicative protesting and, 105–106, 110 Communicative protesting. See also Escapemaintained behavior developmental processes and, 96 overview, 92–96, 93t, 113 parent–child interactions and, 96–98 spoken language and, 112–113 teaching, 99–112, 102f, 103f, 107t, 108f Community shopping list, 239 Competing schedule of reinforcement, 62, 165–166, 239. See also Prespecifying a competing schedule of reinforcement; Reinforcement; Schedule of reinforcement Comprehensiveness, 217–218 Concurrent implementation of interventions, 59–60, 226. See also Intervention strategies Concurrent operants (CO), 43t, 45. See also Preference assessment Concurrent-operants preference assessment, 193, 239 Conditional discrimination, 128, 239, 241 Conditional use of communicative alternatives, 29–30. See also Communicative alternatives Conditional use of newly established behavior definition, 239 generalization and, 225–226 implementing a comprehensive behavior support program and, 48 overview, 49–50, 49t, 226 teaching requesting assistance and, 135–139, 136t, 137f, 140–142, 146–148, 147f Consequence manipulation, 132, 239 Consequence-related intervention strategies. See also Intervention strategies; Punishment attention-maintained behavior and, 198–199 examples of, 46–47 integrative implementation and, 46–47 overview, 39–41 Consistency, 217–218 Constant time delay, 66, 137, 240 Consultation, 40–41 Contextual fit, 227–229 Contingent reinforcement, 42. See also Reinforcement Continuous schedules of reinforcement, 61–62, 240. See also Tolerance for delay in the delivery of reinforcement (TFD) procedure

Index 269 Control function of FCT, 196–197, 240 Controlling prompt, 75, 240. See also Prompting strategies Critical event, 170, 173, 240. See also Motivating operations (MOs) Crying, 97–98 Daily schedules, 70f, 71. See also Schedules Decision tree, 86–87, 87f Delay signal. See also Tolerance for delay in the delivery of reinforcement (TFD) procedure definition, 240 overview, 55, 56–58 requesting and returning from a break and, 165–167 Delayed reinforcement. See also Reinforcement; Tolerance for delay in the delivery of reinforcement (TFD) procedure attention-maintained behavior and, 192 definition, 240 overview, 61–62 requesting and returning from a break and, 162–166 tangible-maintained problem behavior and, 206, 207–211, 210f teaching requesting assistance and, 140–142 Demand fading. See also Antecedent-focused intervention; Fading definition, 240–241 overview, 53t, 58–59 requesting a break and, 153, 155t tangible-maintained problem behavior and, 206, 209–211 Dependency, 31–32, 144–148, 145f, 147f Deprivation assessment and, 220 attention-maintained behavior and, 182 definition, 241 requesting a break and, 150 setting events and, 85–86 Developmental disabilities, 98, 119 Developmental perspective, 17–18 Developmental processes attention-maintained behavior and, 181 communicative protest and, 96 reinforcers for a communicative response and, 4 requesting assistance and, 114–115 Differential reinforcement, 97, 99–100. See also Reinforcement Differential reinforcement of alternative behavior (DRA). See also Prespecifying a competing schedule of reinforcement competing schedule of reinforcement and, 62–63 definition, 241 overview, 1–2

punishment and, 40–41 teaching requesting assistance and, 146–148, 147f Differential reinforcement of other behavior (DRO) approach, 109–110, 152–153 Differentiated reinforcement, 118–119. See also Reinforcement Discrimination, 241 Discriminative stimulus, 34, 241 Disruptive behavior, 116. See also Problem behavior Duration of engagement, 156–158, 161–164, 170–172, 170f, 175. See also Requesting a break Early intervention, 217–218. See also Intervention strategies Effective response. See Response effect Efficient representations, 21–23. See also Representation selection for a particular communicative act Efficient response. See Response efficiency Embedding strategy, 75, 241 Empowerment intervention strategies and, 32–46, 43t overview, 31–32 requesting a break and, 156–157 Engagement duration. See Duration of engagement Enriched break, 201, 241 Environment, 6 Environmental manipulations, 122, 241 Error correction, 99–100, 241 Errorless instruction, 123–124, 241. See also Intervention strategies Escalation of behavior, 40. See also Problem behavior Escape extinction. See also Extinction definition, 241–242 requesting a break and, 151–152, 155t, 157 requesting assistance and, 122 Escape-maintained behavior. See also Communicative protesting; Requesting a break; Requesting assistance; Social function of behavior requesting a break and, 151–152, 159–160 setting events and, 89–91 teaching communicative protesting and, 101–102, 111–112 teaching requesting a break and, 169–170 tolerance for delay in the delivery of reinforcement (TFD) procedure and, 58–60 Explicit delay signal, 56–58, 242. See also Delay signal Explicit instruction, 118–119. See also Intervention strategies

270 Extinction consequences and, 40 definition, 242 overview, 4–8, 7t, 58 requesting a break and, 151–152, 155t requesting assistance and, 122, 138–139 tangible-maintained problem behavior and, 209 teaching communicative protesting and, 104, 111–112 Extinction burst attention-maintained behavior and, 185, 199–200 definition, 242 overview, 104 teaching communicative protesting and, 104–105 Fading. See also Demand fading; Prompt fading; Stimulus fading definition, 242 generalization and, 225–226 tangible-maintained problem behavior and, 206, 207, 209–211, 210f False negative, 180, 242 Fidelity, intervention, 33, 227–231, 242. See also Adherence to intervention; Treatment fidelity Fit, contextual, 227–229 Fixed time schedules, 192, 242. See also Timebased schedules Forced-choice preference assessments, 205. See also Preference assessment Free operant (FO) procedure, 43t, 44–45. See also Preference assessment Free play, 155t Full physical prompts, 123t. See also Physical prompts Functional analysis definition, 242 identifying reinforcers and, 45 overview, 9–12, 9f, 11f, 19–20 requesting assistance and, 116, 125–126 teaching communicative protesting and, 102–105, 102f, 103f teaching requesting a break and, 169–170 Functional approach, 18 Functional behavioral assessments, 19–20, 218–219. See also Functional analysis Functional communication training (FCT) in general. See also Intervention strategies attention-maintained behavior and, 181–196, 183t, 185t, 191t collateral gains from, 227 definition, 242–243 differential reinforcement of alternative behavior (DRA) and, 1–2

Index functional analysis, 9–12, 9f, 11f generalization and, 224–226 maintenance of gains from, 222–224 overview, 1, 234–235 reinforcers for a communicative response, 2–8, 3t, 7t requesting a break and, 154–156, 155t, 161–162, 169 requesting assistance and, 119, 130–131 tangible-maintained problem behavior and, 208–209, 214, 215–216 translational settings and, 232 Functional communicative acts, 16–17, 16t Functional equivalence, 7–8, 243 Functions of a behavior. See also Communicative function; Problem behavior; Social function of behavior communicative alternatives and, 28 definition, 242 overview, 13–15 General and explicit vocabulary items, 21, 243 General case instruction. See also Integrative model of intervention; Intervention strategies communicative alternatives and, 37–38 empowerment and self-efficacy and, 32–46, 43t high-dose and low-dose intervention and, 231 implementing a comprehensive behavior support program and, 47–50, 49t overview, 30, 49–50, 49t, 117 requesting assistance and, 117–131, 123t, 127f tangible-maintained problem behavior and, 211–214 tolerance for delay in the delivery of reinforcement (TFD) procedure and, 59–60 General case logic, 47–50, 49f, 243 General delay signal, 56–58, 243. See also Delay signal Generalization communicative alternatives and, 37–38, 53–54 communicative intents and, 18–19 definition, 243 interventions and, 27 maintenance of gains and, 222–224 overview, 224–226 requesting assistance and, 117–131, 123t, 127f, 135–139, 136t, 137f tangible-maintained problem behavior and, 213 teaching communicative protesting and, 106 Generalization probes definition, 243 overview, 224–225

Index 271 teaching requesting assistance and, 146–148, 147f Gestural communication mode, 112–113, 125 Gestural prompts, 81, 83t, 123t. See also Prompting strategies Gestures, 99–101 Goods or services, behavior maintained by access to. See Access to goods or services, behavior maintained by; Tangible items Graphic organizational aids. See also Antecedentfocused intervention; Schedules choices regarding, 68–80, 70f, 72f communicative protest and, 112–113 definition, 243 examples of, 77–80 overview, 53t, 64–67 Habituation, 149–151, 243 Health, 218 Help, requesting. See Requesting assistance Hierarchy of reinforcers, 205, 243. See also Reinforcers High-dose interventions, 231. See also Intervention strategies Ignoring behaviors, 4–5, 184–185 Immediacy of reinforcement, 107t, 136t, 172t. See also Reinforcement Implementation fidelity, 230–231, 243. See also Adherence to intervention; Treatment fidelity Impulsivity, 31, 62–63 Independence empowerment and self-efficacy and, 31–32 requesting a break and, 150–151 teaching requesting assistance and, 144–148, 145f, 147f Initial free play, 155t Initial requests, 211–216 Instructional control, 156, 244 Instructional procedures. See Intervention strategies Instructional prompts, 112, 174. See also Prompting strategies Integrative implementation, 46–47. See also Integrative model of intervention Integrative model of intervention. See also General case instruction empowerment and self-efficacy and, 32–46, 43t integrative implementation and, 46–47 overview, 28–30 Intentionality, 14–15. See also Communicative intents Intents, communicative. See Communicative intents

Intervention strategies. See also Antecedentfocused intervention; Communicative alternatives; Consequence-related intervention strategies; Functional communication training (FCT) in general; General case instruction; Prompting strategies assessment and, 220–221 attention-maintained behavior and, 181–196, 183t, 185t, 191t contextual fit and, 227–229 empowerment and self-efficacy and, 32–46, 43t fidelity and, 227–231 generalization and, 225–226 high-dose and low-dose, 231 implementing a comprehensive behavior support program and, 47–50, 49t levels of support and, 232–233 maintenance of gains from, 222–224 overview, 50, 234–235 requesting and returning from a break and, 166–169 requesting assistance and, 118–119, 122–125, 123t, 126, 131–148, 133f, 134t, 136t, 137f, 143f, 145f, 147f tangible-maintained problem behavior and, 208–209 teaching communicative protesting, 99–112, 102f, 103f, 107t, 108f translational settings and, 232 validity and, 227–229 Joint attention, 16–17, 16t, 244. See also Communicative function Judgments, 31–32 Least-to-most intrusive prompt hierarchy, 142 Locus of prompt control, 83t. See also Prompting strategies Low-dose interventions, 231. See also Intervention strategies Magnitude of a prompt. See also Prompting strategies definition, 244 overview, 83t teaching requesting assistance and, 146–148, 147f Maintenance of communicative alternatives, 222–224. See also Communicative alternatives; Response strength Mands attention-maintained behavior and, 183 consequences and, 39–40 definition, 244

272 Mands (cont.) intentionality and, 15 overview, 1–2, 222 requesting a break and, 155t requesting assistance and, 119 tangible-maintained problem behavior and, 209 teaching communicative protesting and, 105–106 Means, communicative. See Communicative means Model prompts, 81, 123t, 154. See also Prompting strategies Modeling, 99–100, 244 Most-to-least sequence of prompt delivery. See also Prompting strategies communicative protest and, 110–111 definition, 244 requesting assistance and, 142 Motivating operations (MOs) antecedent-focused intervention and, 84, 85–89, 87f, 88f, 91 assessment and, 219–220 attention-maintained behavior and, 180, 185 definition, 244 intervention strategies and, 234–235 overview, 6 requesting a break and, 153, 169–170 requesting assistance and, 126, 132–133, 133f, 148 setting events and, 84, 85–89, 87f, 88f tangible-maintained problem behavior and, 214 teaching communicative protesting and, 104, 111 Multicomponent intervention, 226. See also Intervention strategies Multielement design, 56, 244 Multiple stimuli without replacement (MSWO) procedure, 43t, 44–45, 205. See also Preference assessment Mutual gaze, 244 Natural consequences, 40. See also Consequencerelated intervention strategies Natural prompt, 75, 245. See also Prompting strategies Negative reinforcement. See also Reinforcement attention-maintained behavior and, 181–182, 184–185 communicative protest and, 93–94 definition, 245 identifying reinforcers and, 45 maintenance of gains and, 223–224 overview, 4–5 requesting assistance and, 124, 125–126, 128

Index Negative teaching examples. See Positive and negative teaching examples Noncompliance, 168 Noncontingent reinforcement (NCR). See also Reinforcement; Schedule of reinforcement attention-maintained behavior and, 186–187, 190, 191t, 193–196, 199–200 definition, 245 overview, 41–42 tangible-maintained problem behavior and, 203t teaching communicative protesting and, 111 Observer agreement, 229, 245 Overgeneralization. See also Generalization antecedent-focused intervention and, 53–54 definition, 245 empowerment and self-efficacy and, 32 Overreliance on a newly established behavior, 144–148, 145f, 147f Paired stimulus procedure, 43–44, 43t. See also Preference assessment Parent–child interactions, 96–98 Partial physical prompts, 123t. See also Physical prompts Physical environment setting event, 84f. See also Setting event Physical prompts. See also Prompting strategies attention-maintained behavior and, 191 overview, 81, 83t requesting a break and, 154 requesting assistance and, 123t, 137 Physiological setting event, 84f. See also Setting event Picture prompts, 82, 83t. See also Graphic organizational aids; Prompting strategies Play/work areas, 155t Play/work cards, 155t Positive and negative teaching examples communicative protesting and, 104–105 definition, 245 implementing a comprehensive behavior support program and, 48 requesting a break and, 171 requesting assistance and, 133–134, 134t Positive reinforcement. See also Reinforcement attention-maintained behavior and, 183–184, 183t, 197 identifying reinforcers and, 45 maintenance of gains and, 223–224 requesting a break and, 161–162 requesting assistance and, 126, 128 setting events and, 85–86 tangible-maintained problem behavior and, 204

Index 273 Preference assessment. See also Assessment; Concurrent operants (CO); Forced-choice preference assessments; Free operant (FO) procedure; Multiple stimuli without replacement (MSWO) procedure definition, 245 reinforcers and, 42–46, 43t requesting a break and, 155t selection of alternative communicative behaviors and, 27 tangible reinforcers and, 202 tangible-maintained problem behavior and, 204–205, 206, 207 Premack principle, 74–75, 245 Present setting event, 85f. See also Setting event Prespecifying a competing schedule of reinforcement, 53t, 62–64. See also Antecedent-focused intervention; Reinforcement Prevention attention-maintained behavior and, 183–189, 183t, 185t levels of support and, 232–233 Problem behavior. See also Attention-maintained behavior; Functions of a behavior; Social function of behavior addressing, 217–218 communicative intents and, 17–19 communicative protest and, 95–96, 98 consequences and, 39–40 empowerment and self-efficacy and, 32–46, 43t functional analysis and, 9–12, 9f, 11f functional communicative acts and, 16–17, 16t functions of, 7–8, 7t implementing a comprehensive behavior support program and, 47–50, 49t intervention strategies and, 32–46, 43t, 234–235 levels of support and, 232–233 maintenance of, 218–219 parent–child interactions and, 98 prompting strategies and, 82 reinforcement and, 2–8, 3t, 7t requesting a break and, 153–156, 155t, 171–172, 172t requesting assistance and, 116, 124, 132–133, 133f, 135–139, 136t, 137f, 148 selection of alternative communicative behaviors and, 23–27, 25t self-regulation and, 31 setting events and, 85–89, 87f, 88f tangible-maintained problem behavior, 202–204, 203t teaching communicative protesting and, 101–102, 107–108, 107t, 109–110 Procedural fidelity/treatment integrity, 229, 246 Productive joint attention, 244

Progress monitoring requesting a break and, 175–177, 176f, 177f requesting assistance and, 142–144, 143f Prompt fading. See also Antecedent-focused intervention; Fading; Prompting strategies attention-maintained behavior and, 194–195 communicative protesting and, 112 definition, 246 generalization and, 225–226 overview, 53t, 75, 81, 82 requesting a break and, 174 requesting assistance and, 140–142 tangible-maintained problem behavior and, 207 Prompting strategies. See also Prompt fading attention-maintained behavior and, 193–195 overview, 81–84, 83t requesting a break and, 153–154, 155t, 173–174 requesting assistance and, 117–125, 123t, 137–138, 140–142, 146–148, 147f schedules and, 75–76 teaching communicative protesting and, 110–112 Protesting. See Communicative protesting Protodeclaratives, 246 Provoking event, 108, 108f, 110 Punishment. See also Consequence-related intervention strategies attention-maintained behavior and, 183–189, 183t, 185t definition, 246 overview, 7–8, 7t, 39–40 requesting a break and, 155t Quality of reinforcement. See also Reinforcement communicative protesting and, 107t requesting a break and, 172t requesting assistance and, 136t Range of positive teaching examples, 133–134, 134t, 246. See also Positive and negative teaching examples Rapport building, 89–91, 238 Rate of reinforcement, 107t, 136t, 172t. See also Reinforcement Receptive joint attention, 244 Rehearsal strategy, 123–124 Reinforcement. See also Negative reinforcement; Noncontingent reinforcement (NCR); Prespecifying a competing schedule of reinforcement; Reinforcers; Tolerance for delay in the delivery of reinforcement (TFD) procedure antecedent-focused intervention and, 33–36 attention-maintained behavior and, 179–180, 181–182, 183–189, 183t, 185t, 193–196, 197, 198–200

274 Reinforcement (cont.) behavior support plan, 221 communicative alternatives and, 28–29, 222 communicative protest and, 93–94 delayed, 61–62 for desired behaviors, 41–46, 43t extinction and, 4–8, 7t general case instruction and, 30 identifying reinforcers, 42–46, 43t implementing a comprehensive behavior support program and, 47–50, 49t integrative implementation and, 46–47 maintenance of gains and, 223–224 requesting a break and, 171–172, 172t, 173–174 requesting and returning from a break and, 155t, 161–162, 162–166 requesting assistance and, 118–119, 120–122, 124, 125–126, 128, 130–131, 136t, 137–139 selection of alternative communicative behaviors and, 24–26, 25t tangible-maintained problem behavior and, 203–204, 203t teaching communicative protesting and, 106, 107t, 109–110, 111 Reinforcer assessment, 246 Reinforcers. See also Access to goods or services, behavior maintained by; Reinforcement; Tangible items attention-maintained behavior and, 179–180 competing schedule of reinforcement and, 62–63 hierarchy of, 205 identifying, 42–46, 43t overview, 201–202 schedules and, 74 teaching requesting a break and, 173 Reinforcers for a communicative response, 2–8, 3t, 7t Rejecting. See Communicative protesting Release cue, 155t, 156, 167 Release point of a prompt, 83t. See also Prompting strategies Release signal, 55, 246. See also Tolerance for delay in the delivery of reinforcement (TFD) procedure Representation selection for a particular communicative act, 21–23 Representations used. See also Symbols used requesting a break and, 161–162 schedules and, 73 specificity of, 14, 21–23, 246 tangible-maintained problem behavior and, 207, 212–213 teaching requesting a break and, 174–175

Index Requesting a break. See also Communicative protesting competing schedule of reinforcement and, 165–166 examples of, 157–160 moderation in the use of, 164–165 overview, 93, 93t, 177–178 returning from a break, 161–164 situations that support, 149–161, 155t teaching, 169–177, 170f, 172t, 176f, 177f tolerance for delay in the delivery of reinforcement (TFD) procedure and, 166–169 Requesting assistance. See also Communicative protesting developmental processes and, 114–115 general case instruction and, 117–131, 123t, 127f overview, 93, 93t, 114, 148 situations that support, 115–117 teaching, 131–148, 133f, 134t, 136t, 137f, 143f, 145f, 147f Requesting assistance progress form, 142–144, 143f Requests for attention, 186–187. See also Attention-maintained behavior Respite. See Requesting a break Response chain. See Chain of behavior (response chain) Response class, 3–4, 246 Response cost definition, 246 overview, 7–8 requesting a break and, 155t, 159 Response effect, 107t, 136t Response efficiency attention-maintained behavior and, 186–187, 197–198 communicative protest and, 107–108, 107t generalization limitations and, 117–125, 123t requesting a break and, 171, 172t requesting assistance and, 136t Response effort, 136t Response generalization, 38. See also Generalization Response prompts. See also Prompting strategies definition, 247 requesting assistance and, 117–125, 123t teaching communicative protesting and, 112 Response shaping, 97, 247 Response strategy, 120–121 Response strength, 195–196 Response to intervention, 233 Response-prompting systems, 81–82. See also Prompting strategies Resurgence, 6–7, 25–26, 223–224, 247

Index 275 Returning from a break, 161–164, 172–173. See also Requesting a break Rigor, 231 Routines. See also Graphic organizational aids choices regarding, 68–80, 70f, 72f examples of, 77–80 graphic organizational aids and, 64–67 tangible-maintained problem behavior and, 207–211, 210f Safety signal, 167. See also Release cue Safety spot, 55–56, 161–162, 205–207. See also Tolerance for delay in the delivery of reinforcement (TFD) procedure Satiation assessment and, 220 attention-maintained behavior and, 182 definition, 247 motivating operations, 6 requesting a break and, 149–151 setting events and, 85–86 tangible-maintained problem behavior and, 202 teaching communicative protesting and, 106 Schedule of reinforcement. See also Competing schedule of reinforcement; Noncontingent reinforcement (NCR); Reinforcement attention-maintained behavior and, 187–189 definition, 247 requesting and returning from a break and, 165–166 requesting assistance and, 118–119 tangible-maintained problem behavior and, 203–204 Scheduled attention. See Noncontingent reinforcement (NCR) Schedules. See also Graphic organizational aids choices regarding, 68–80, 70f, 72f examples of, 77–80 graphic organizational aids and, 64–67 Schoolwide behavior support initiatives, 232–233 Self-efficacy, 31–32 Self-regulation antecedent-focused intervention and, 62–63 communicative protest and, 97 definition, 247 implementing a comprehensive behavior support program and, 47–50, 49f intervention strategies and, 32–46, 43t, 226 overview, 30–31 requesting a break and, 150, 158 Sequential implementation of interventions. See also Intervention strategies antecedent-focused intervention and, 60 teaching communicative protesting and, 109–112 teaching requesting assistance and, 139–141

Services, behavior maintained by access to. See Access to goods or services, behavior maintained by; Tangible items Setting event. See also Antecedent-focused intervention building rapport and, 89–91 compared to motivating operations (MOs), 85–89, 87f, 88f definition, 247 examples of, 87–89, 88f overview, 84–85, 84f, 85f, 91 Setting-event interventions, 84–91, 84f, 85f, 87f, 88f. See also Antecedent-focused intervention; Setting event Shopping lists, 71–73. See also Graphic organizational aids Signal fading, 206, 207, 209–211. See also Fading Signaled reinforcement. See also Antecedentfocused intervention; Tolerance for delay in the delivery of reinforcement (TFD) procedure overview, 53t, 54–62 tangible-maintained problem behavior and, 207–208 teaching communicative protesting and, 110–111 Simple discrimination, 241, 247 Social acceptability, 28–29 Social activity setting event, 84f. See also Setting event Social function of behavior. See also Functions of a behavior; Problem behavior communicative intents and, 17–20 definition, 247 overview, 13–14 tolerance for delay in the delivery of reinforcement (TFD) procedure and, 58–61 Social interaction, 16–17, 16t, 247–248. See also Communicative function Social pragmatic orientation, 17–18 Social validity, 227–229 Socially maintained problem behavior, 2n. See also Attention-maintained behavior Spoken language, 4, 112–113. See also Verbal prompts Stimulus control, 101, 248 Stimulus fading, 81, 210–211, 210f. See also Fading; Prompt fading Stimulus generalization, 37–39, 130–131, 223. See also Generalization Stimulus prompting, 81. See also Prompting strategies Symbol repertoire, 21–23. See also Representation selection for a particular communicative act

276 Symbols used. See also Representations used requesting a break and, 161–162 schedules and, 73, 75–77 sequence of, 76–77 specificity of, 21–23 tangible-maintained problem behavior and, 207, 212–213 teaching requesting a break and, 174–175 Tacts, 20, 248 Tangible items. See also Access to goods or services, behavior maintained by; Reinforcers definition, 248 functional communication training and, 202–216, 203t, 210f overview, 201, 216 safety spot and, 205–207 Tangible-maintained problem behavior, 201–216, 203t, 210f. See also Access to goods or services, behavior maintained by Tantruming, 114–115 Task aversion, 149–150 Task demands, 132, 248 Three-step prompting, 155t. See also Prompting strategies Three-tiered implementation framework, 232–233 Time-based schedules. See also Schedules attention-maintained behavior and, 192 definition, 248 overview, 65, 66–67 Time-contingent positive reinforcement, 204, 206, 248. See also Positive reinforcement Time delay prompt-fading strategy, 82, 83t, 248. See also Prompt fading Time delay prompting, 191–192

Index Time out, 8, 248 Timer, 155t To-do lists. See also Graphic organizational aids choices regarding, 71, 72f definition, 248 displaying, 74 Tolerance for delay in the delivery of reinforcement (TFD) procedure. See also Reinforcement; Signaled reinforcement antecedent-focused intervention and, 91 definition, 248 maintenance of gains and, 224 overview, 47, 54–62 requesting a break and, 153, 156, 162, 164–165, 166–169 setting-event interventions and, 84 teaching requesting a break and, 174–175 Treatment fidelity, 95, 227–231. See also Adherence to intervention; Fidelity, intervention Validity, social, 227–229 Variable time schedules, 192, 242. See also Timebased schedules Verbal prompts. See also Prompting strategies overview, 82, 83t requesting a break and, 154 requesting assistance and, 123t tangible-maintained problem behavior and, 212–213 Visual prompts, 123t, 207–211, 210f. See also Prompting strategies Within-activity schedules, 64–65. See also Schedules Within-prompt-type fading strategy, 82, 83t. See also Prompt fading