Research in Developmental Disabilities 33 (2012) 1462–1468

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Research in Developmental Disabilities

Examination of an antecedent communication intervention to reducetangibly maintained challenging behavior: A controlled analog analysis

Mark O’Reilly a,*, Christina Fragale a, Summer Gainey a, Soyeon Kang a, Heather Koch a,Jennifer Shubert a, Farah El Zein a, Deanna Longino a, Moon Chung a, Ziwei Xu a, Pamela White a,Russell Lang b, Tonya Davis c, Mandy Rispoli d, Giulio Lancioni e, Robert Didden f, Olive Healy g,Deborah Kagohara h, Larah van der Meer h, Jeff Sigafoos h

a The University of Texas at Austin, USAb Texas State University-San Marcos, USAc Baylor University, USAd Texas A&M University, College Station, USAe University of Bari, Italyf Radbound University, The Netherlandsg University College Galway, Irelandh Victoria University of Wellington, New Zealand

A R T I C L E I N F O

Article history:

Received 7 March 2012

Accepted 8 March 2012

Available online 26 April 2012

Keywords:

Challenging behavior

Functional analysis

Motivating operations

Communication

Developmental disorder

A B S T R A C T

We examined the influence of an antecedent communication intervention on challenging

behavior for three students with developmental disorders. Students were taught to

request tangible items that were identified as reinforcers for challenging behavior in a

prior functional analysis. Individual participant multielement and reversal designs were

used to compare the effects of the antecedent communication intervention versus a no

antecedent communication intervention condition. Immediately following the antecedent

manipulations students were exposed to the tangible condition of the functional analysis.

Results indicate that the antecedent communication intervention reduced challenging

behavior in the subsequent tangible test condition for all three students. The importance of

examining antecedent interventions to treat challenging behavior from a function analytic

perspective is discussed.

� 2012 Elsevier Ltd. All rights reserved.

Despite the considerable amount of research effort dedicated to the assessment and treatment of aberrant behavior withindividuals with developmental disabilities such behaviors continue to be a major concern for clinicians, support staff, andfamilies (Emerson & Einfeld, 2011). Aberrant behavior such as self-injury, aggression, and property destruction can be sosevere as to require clinical intervention with as many as 15% of this population (Sigafoos, Arthur, & O’Reilly, 2003).Subgroups of this population, such as those with autism spectrum disorders or severe multiple disabilities may displayhigher rates of clinically significant aberrant behavior (Matson et al., 2011; Poppes, van der Putten, & Vlaskamp, 2010).Research on the assessment and treatment of aberrant behavior therefore remains a priority with this population (Emerson& Einfeld, 2011).

Behavioral interventions designed to treat aberrant behavior with this population can be broadly classed into two generalcategories – consequence and antecedent based. Contemporary consequence-based strategies typically involve

* Corresponding author at: Department of Special Education, 1 University Station D5300, The University of Texas at Austin, Austin, TX 78712, USA.

E-mail address: markoreilly@mail.utexas.edu (M. O’Reilly).

0891-4222/$ – see front matter � 2012 Elsevier Ltd. All rights reserved.

doi:10.1016/j.ridd.2012.03.017

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manipulating reinforcement contingencies to reduce aberrant behavior and increase appropriate alternative behavior(Kahng, Iwata, & Lewin, 2002). Consequence-based interventions are typically preceded by a functional assessment designedto identify the consequences maintaining challenging behavior (e.g., Iwata, Dorsey, Slifer, Bauman, & Richman, 1994;Paclawskyj, Matson, Rush, Smalls, & Vollmer, 2000). Interventions are then tailored to the consequences identified asmaintaining challenging behavior during the functional assessment. An example of such a consequence-based interventionis functional communication training (FCT; Carr & Durand, 1985). In essence FCT involves identifying the consequencesmaintaining aberrant behavior and then teaching the person alternative appropriate responses to access those sameconsequences. During FCT, aberrant behavior is typically placed on extinction, while the new communication responses arereinforced on an FR1 schedule. This differential reinforcement is intended to increase the efficiency of the newcommunication response and decrease the probability of aberrant behavior.

Antecedent-based interventions, in contrast, include a series of strategies that are implemented prior to aberrantbehavior that reduce the probability of this behavior occurring (Luiselli, 2006). Some of these strategies include: modifyingactivities or routines (Mesibov, Browder, & Kirkland, 2002; O’Reilly, Sigafoos, Lancioni, Edrisinha, & Andrews, 2005; O’Reilly,Sigafoos, et al., 2006); involving students in making choices (Cannella, O’Reilly, & Lancioni, 2005); teaching communicationand social skills (O’Reilly, Cannella, Sigafoos, & Lancioni, 2006). These interventions have been shown to be associated withreductions in aberrant behavior and are touted as a cornerstone of the positive behavioral support movement (Carr et al.,2002). In contrast to consequence-based interventions these antecedent-based strategies are not necessarily selected from,or tailored to, a prior functional assessment of the aberrant behavior. This is a critical issue because when antecedentinterventions do work, it may nonetheless be unclear why they work and visa versa. In fact the rationale for the effectivenessof these antecedent interventions is sometimes couched in terms of enhancing the freedom and dignity of the person (i.e.,positive behavior support). While these sentiments are laudable they do not enhance our scientific understanding of thefunctional properties of such antecedent interventions.

A small but emerging body of research is beginning to examine the functional properties of antecedent interventions inthe treatment of aberrant behavior with this population (Berg et al., 2000; McComas, Thompson, & Johnson, 2003; O’Reilly,Edrisinha, Sigafoos, Lancioni, Cannella, et al., 2007; O’Reilly, Lacey, & Lancioni, 2000; O’Reilly, Lancioni, & Emerson, 1999;O’Reilly, Richman, et al., 2000; O’Reilly et al., 2008, 2009; Roantree & Kennedy, 2006). This research differs from the previouswork cited above in that it is driven by a systematic conceptual approach that examines the functional relations betweenantecedent variables and the discriminated operant (McGill, 1999). Within this conceptual system these antecedentinterventions can be broadly classified as motivating operations (MOs) that influence the evocative effects of discriminativestimuli and alter the value of reinforcers for challenging behavior (Langthorne, McGill, & O’Reilly, 2007; Laraway, Snycerski,Michael, & Poling, 2003). This research on the functional properties of antecedent interventions to treat aberrant behaviorcan be classified into two generic strands: (a) clarifying the functional properties of these antecedent variables (e.g.,Edrisinha, O’Reilly, Sigafoos, Lancioni, & Choi, 2011; O’Reilly, Cannella, et al., 2006; O’Reilly, Edrisinha, Sigafoos, Lancioni,Machalicek, et al., 2007; O’Reilly, Sigafoos, et al., 2006); and (b) examining the application of these variables in the treatmentof aberrant behavior (e.g., Davis et al., 2009; Lang et al., 2010; Rispoli et al., 2011).

These preliminary investigations on the use of MOs as antecedent interventions to treat aberrant behavior have producedpositive results. For example, Rispoli et al. (2011) determined through prior functional analyses that aberrant behaviors(throwing objects, screaming) were maintained by access to tangible items for two young school children with autism. Priorto regular classroom activities (where these behaviors were problematic) the children were given continuous access to theidentified tangible items (certain children’s books, coloring pens, etc.) until they began to reject them. This interventionappeared to produce a satiation effect, reducing the reinforcing value of these items. Subsequent to this access (satiation)intervention aberrant behavior was dramatically reduced during classroom activities. Lang et al. (2010) introduced a similaraccess (satiation) intervention to reduce aberrant behavior during play interventions for young children with autism. Unlikemany other antecedent interventions the effects of this access (satiation) intervention can be understood in terms of howMOs enter into a functional relation with the discriminated operant. In other words we can understand the effects of thisintervention within a scientific framework. That is, the access condition decreases the evocative effectiveness of thediscriminative stimuli and the power of the reinforcing consequences for the targeted aberrant behaviors, therebyeliminating or reducing such behaviors.

A vital next step in this body of research is to translate such effective MO treatment strategies in a manner that they areacceptable and capable of being integrated into regular routines and implemented by service providers such as teachers andparents. For example, while access (satiation) proved effective as an MO intervention in the studies cited above theintervention itself might not be manageable in many classrooms (e.g., allowing the child to have unlimited free access totangibles items for up to 30 min). And even if such strategies were manageable in a classroom they might not be seen asacceptable to many teachers as the child is not being taught anything during this period.

One possible way to enhance the acceptability/applicability of such an intervention might be to embed access (satiation)within the context of instructional programming. For example, if a child engages in aberrant behavior to access attention ortangible items then an MO intervention might include teaching the child to produce an appropriate communication response(FCT) to gain access to the reinforcer, then delivering copious access to the reinforcer during communication training. In thisway the child is being taught a functional communication skill and receiving almost continuous access to the consequencemaintaining aberrant behavior (MO intervention to produce satiation). Of course the efficacy of such an intervention ismerely conjecture and requires empirical evidence. Such research should be conducted under tightly controlled

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experimental conditions initially to examine the effectiveness of this embedded MO intervention prior to testing its efficacyin applied contexts such as school settings.

In the current study we examined the effectiveness of a communication intervention coupled with access to largeamounts of the consequences maintaining aberrant behavior (MO) as an antecedent intervention with three children withdevelopmental disabilities. Prior functional analyses indicated that aberrant behavior was maintained by access to tangibleitems for all three children. Aberrant behavior under the tangible condition of the functional analysis was comparedimmediately following the communication intervention versus no communication intervention. This analysis wasconducted to determine whether the communication intervention (incorporating access to the tangible items maintainingaberrant behavior) would function as a MO to reduce tangibly maintained aberrant behavior.

1. Methods

1.1. Participants and settings

Three students (Matthew, Mark, and Luke) aged 5, 9, and 5 years respectively, participated in the study. All three studentswere diagnosed with a variety of developmental disorders including autism. Matthew, Mark, and Luke scored 36.5, 46, and32.5 on the Childhood Autism Rating Scale (CARS; Schopler, Reichler, & Renner, 1988) respectively indicating that theyfunctioned in the moderate to severe range of autism. Teachers reported that Matthew rarely spoke but could follow simpletwo-step directions. Often he would tend to perseverate on sounds, verbally echoing them. Mark’s teachers reported that hecould follow simple one-step directions and adhere to school routines if given a picture schedule. He communicated usingone-word approximations or by leading an adult by the hand. Luke could spontaneously request using phrases and couldfollow multiple-step directions according to his teachers. He also tended to recite phrases from preferred television showsand movies.

Each of these three students spent a large proportion of their school day engrossed with particular items (Matthew –computer toy; Mark – Magna Doodle; Luke – iPad). Engagement with these items was predominantly nonfunctional (e.g.,Mark repeatedly drew approximations of four letters). Aberrant behavior occurred (described below) when teachersattempted to redirect the students from these items to other classroom activities.

Matthew and Luke attended private schools that served children with language and developmental delays. Markattended a public school where he received special education services in a self-contained classroom. All assessments andinterventions reported in this study were conducted in an empty classroom in each of the students’ respective schools.

1.2. Target behaviors and response measurement

Target aberrant behaviors for each student were identified through interview with the teachers followed by informalobservation of the students in their classrooms by the second author (C. Fragale). Target behaviors for Matthew and Lukeincluded elopement, flopping, and yelling. Elopement was defined as moving more that 3 ft away from the table. Flopping wasdefined as throwing the body on the ground with refusal or resistance to prompts to stand up. Yelling was defined as high-pitched utterances above the conversational level (e.g., ‘‘eeeee’’ and ‘‘ahhh’’ for Matthew and ‘‘my iPad’’, ‘‘noooo’’, or ‘‘help’’for Luke). Target behaviors for Mark included head slaps and biting. Head slaps was defined as repeatedly hitting the headwith the palm of one or both hands three or more times with less than 3 s between hits. Biting was defined as teeth on his skinor attempts to bite others (moving toward another person with an open mouth). Head slaps or biting were relatively mildbehaviors and did not cause any bruising. All sessions of the functional analysis and sessions following the antecedentcommunication intervention were videotaped and aberrant behavior was assessed using a 10 s partial interval recordingsystem.

1.3. Experimental design

Individual participant multielement and ABAB designs (Barlow, Nock, & Hersen, 2009) were used to evaluate maintainingcontingencies (see Section 1.4) and the effects of the MO intervention (see Section 1.5) on aberrant behavior.

1.4. Functional analysis

A functional analysis was conducted for each student to determine contingencies maintaining aberrant behavior. Theprotocol used in the functional analysis was similar to that described by Iwata et al. (1982/1994). Each student was exposedto five 10-min sessions of each of four conditions in a multielement design format. The four conditions included attention,demand, tangible, and play. During the tangible condition students gained access to their favorite classroom items describedabove (e.g., iPad for Luke) contingent upon aberrant behavior. That is, when the student yelled, eloped, or flopped etc. theyreceived 10 s access to the favorite item, at which point the item was removed and then reintroduced for a further 10 scontingent upon another occurrence of aberrant behavior. In the attention condition students received 10 s of attentioncontingent upon challenging behavior but were otherwise ignored by the therapist. During the demand condition

instructional tasks were presented that the students had difficulty completing. Tasks were removed for 10 s contingent upon

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challenging behavior and were then re-introduced. In the play condition preferred toys (identified by the teachers and not thesame items used in the tangible test condition) were available, no tasks were presented, and the therapist interacted in apleasant manner with the student on an FT 10 s schedule.

1.5. Evaluation of antecedent communication intervention

Students were exposed to an antecedent communication versus no antecedent communication intervention in amultielement or reversal design format. Immediately following the antecedent conditions the students were again exposedto the tangible condition (one 10-min session) of the functional analysis. Aberrant behavior occurred predominantly in thetangible condition of the previous functional analysis for all students (see Section 2). Therefore the tangible condition wasused as a test condition to examine the effects of the antecedent communication intervention on aberrant behavior in thisphase of the study.

1.5.1. Antecedent communication intervention

Each of the three students was taught to mand for the items associated with aberrant behavior while all aberrant behaviorwas ignored. A 0 s time delay was used to teach the targeted mand to Matthew (‘‘Can I have little computer?’’), Mark(‘‘Doodle?’’), and Luke (‘‘Can I have iPad?’’). The therapist presented the item and simultaneously stated the targeted mand.Once the student repeated the mand they were given immediate access to the item. The student then had access to the itemfor 30 s at which point it was removed and immediately represented by the therapist coupled with the targeted mand phrase.Each antecedent communication session consisted of 20 mand trials for Matthew and Luke. Matthew and Luke therefore hadaccess to their preferred item for 10 min and 30 s during each antecedent communication intervention session. Markreceived 30 mand trials during antecedent communication intervention sessions. Therefore Mark had access to his item for15 min 30 s during the antecedent communication intervention sessions. Immediately following an antecedentcommunication intervention session, the students were then exposed to the tangible condition (one 10-min session) ofthe functional analysis.

1.5.2. No antecedent communication intervention

In this condition students were involved in their typical classroom routines. Also, they did not have access to theirpreferred items (e.g., iPad) for at least 2 h prior to being exposed to the tangible condition (one 10-min session) of thefunctional analysis.

1.6. Reliability and procedural integrity

Two independent observers simultaneously scored aberrant behavior (using the video recordings) on 33% of sessions ofthe functional analysis and antecedent communication intervention evaluation (the tangible sessions following theantecedent conditions) using a 10-s partial interval recording system. Interobserver agreement was calculated on aninterval-by-interval basis by dividing the number of agreements (occurrence and nonoccurrence) by the total number ofagreements plus disagreements in each session and multiplying by 100%. Mean agreement for aberrant behavior during thefunctional analyses was 96% (range, 83–100%), 97% (range, 93–100%), and 97.6% (range, 90–100%) for Matthew, Mark, andLuke, respectively. Mean agreement for aberrant behavior during the tangible sessions of the antecedent communicationevaluation was 94% (range, 83–100%), 96.5% (range, 93–100%), and 97.8% (range, 93.1–100%) for Matthew, Mark, and Lukerespectively.

Procedural integrity was measured on 33% of opportunities of the functional analysis, antecedent communicationintervention, and no antecedent communication intervention protocols. A task analysis of each of these protocols wasdeveloped. An independent observer then scored implementation of the functional analysis protocols and the antecedenttreatment conditions using these task analyses. Procedural integrity was calculated by dividing the number of correct stepsof the task analyses by the total number of steps and multiplying by 100%. Overall procedural integrity was 98%.

2. Results

The results of the functional analyses for Matthew, Mark, and Luke are presented in Fig. 1. Aberrant behavior occurredpredominantly within the tangible condition of the functional analysis for all three students. These results indicate thataberrant behavior was maintained by access to their preferred tangible items (small computer, Magna Doodle, and iPad) forthe three students.

The results of the antecedent communication intervention for Matthew, Mark, and Luke are presented in Fig. 2. Each datapoint in these graphs represents the percentage of intervals with aberrant behavior during a 10-min tangible sessionfollowing either the antecedent communication intervention or the no antecedent communication condition.

Aberrant behavior was relatively lower for all three students following the antecedent communication intervention(M = 13.6%, 7.1%, 1% of intervals for Matthew, Mark, and Luke, respectively). Aberrant behavior was relatively higher for thestudents following the no antecedent communication condition (M = 48.7%, 33.1%, 68.8% of intervals for Matthew, Mark, andLuke, respectively).

Fig. 1. Percentage of intervals with aberrant behavior during attention, demand, tangible, and play conditions for Matthew (top panel), Mark (middle panel),

and Luke (bottom panel).

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3. Discussion

In this study we demonstrated that an antecedent communication intervention incorporating access to identifiedreinforcers for challenging behavior was effective in reducing challenging behavior. During the first phase of the study wedemonstrated that challenging behavior was primarily maintained by access to tangible items for the three students. In thesecond phase of the study we evaluated a communication intervention that included rich access to the reinforcers forchallenging behavior identified in the prior functional analysis. The antecedent communication intervention reducedchallenging behavior in the subsequent tangible test condition. Presession access to reinforcers for challenging behavior canact as an abolishing operation as demonstrated in this and previous research (e.g., Berg et al., 2000; McComas et al., 2003;O’Reilly et al., 2009; Rispoli et al., 2011). This current study extends the previous literature by demonstrating that presessionaccess interventions can be successfully incorporated within a regular classroom instructional activity (such as acommunication intervention).

This study presents a methodology for the systematic examination of the functional properties of antecedentinterventions for challenging behavior. Antecedent interventions are conceptualized as motivating operations – stimuli orconditions that alter the effect of discriminative stimuli and the value of reinforcing consequences. This conceptualizationrequires that we first isolate challenging behavior as a discriminated operant and then hold such experimental conditionsconstant while we systematically examine the influence of putative antecedent interventions on the discriminatedoperant. The analog functional analysis is designed to experimentally isolate challenging behavior as a discriminatedoperant. Analog functional analysis has been a critical methodological tool in the development of this recent body ofresearch on motivating operations as antecedent interventions for challenging behavior (e.g., Lang et al., 2010; McComaset al., 2003).

Fig. 2. Percentage of intervals with aberrant behavior during the tangible condition following the antecedent communication versus the no antecedent

communication conditions for Matthew (top panel), Mark (middle panel), and Luke (bottom panel).

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This study is part of a growing body of research based on a systematic understanding of how antecedent variables enterinto a functional relationship with the discriminated operant (e.g., Langthorne et al., 2007; Laraway et al., 2003; McGill,1999). As mentioned in the introduction, a substantial body of published literature has demonstrated the positive effects ofvarious antecedent interventions on challenging behavior with individuals with developmental disabilities (Luiselli, 2006).However, a truly scientific understanding (functional analysis) of why many of these antecedent interventions are effectivehas not occurred. Until we examine how interventions such as modifying a student’s routines/schedules impact the effects ofdiscriminative stimuli and the value of reinforcers for challenging behavior we are relegated to pseudoscientific explanations(e.g., empowerment, self-determination) for why these strategies work.

The antecedent communication intervention reduced, but did not eliminate, challenging behavior for Matthew and Mark.This seems to be a relatively common finding with other studies that have examined presession access to reinforcers forchallenging behavior (e.g., Lang et al., 2010; O’Reilly et al., 2008). Given these findings, such antecedent interventions shouldnot be seen as a panacea in the treatment of challenging behavior. Rather, antecedent interventions might be most effectivewhen combined with consequence-based interventions (e.g., FCT) in treatment. Future research might examine functionallyderived combinations of treatments (antecedent and consequence based treatments) versus consequence only treatmentson challenging behavior. For example, it may be the case that consequence-based strategies might be easier to implement ifchallenging behavior is initially reduced using antecedent-based strategies.

This is the first study to incorporate a functionally derived antecedent intervention (presession access to tangibles) withina typical curricular activity (communication training). While the results of this intervention are consistent both within andacross the three participants, these methods should be replicated across additional participants. Future research should also

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examine the effectiveness of incorporating presession access interventions into other components of the school routine (e.g.,play, self-care, etc.).

We used the tangible condition of the functional analysis as a test condition to examine the effects of the antecedentcommunication intervention on tangibly maintained challenging behavior. The tangible test condition is a tightly controlledexperimental preparation and may not be indicative of the complexities present in a regular classroom environmentfollowing the antecedent intervention. Future research should test the applied veracity of this antecedent communicationintervention by examining the effects on challenging behavior within regular classroom activities.

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