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LAURA C. CHEZAN
Discrete -Trial Functional Analysis of Problem Behavior and Functional
Communication Training in Three Adults with a Dual Diagnosis of an Intellectual
Disability and a Mental Illness
INTRODUCTION
Context
Intellectual
Disability
Mental Illness
Dual Diagnosi
s
Problem Behavior
Context Cont’d
Approach to Problem Behavior
BEHAVIORAL INTERVENTIONS
Behavior is influenced by environmental variables
1. Assess to identify function2. Teach replacement behavior
Participants’ Selection
All Participants
Functional
Assessment
Trial-Based Functional Analysis
Intervention (FCT)
Discrimination
Assessment
Behavioral
Assessment
PARTICIPANTS AND SETTINGS
Participants’ Selection
Meeting with directors
Informal observation of potential participants
Meeting with staff members
Selection of participants
Participants’ Characteristics
Participa
nt
Age Diagnosis Problem Behavior
Antoine 27 moderate ID
bipolar-
disorder
autism
SIB
repetitive verbal and
motor behavior
Rick 32 profound ID
mood disorder
SIB
physical aggression
property destruction
Tonya 23 severe ID
psychosis
NOS
snatching food
physical aggressionNote: ID = intellectual disability; SIB = self-injurious behavior
Participant
Type of Program
Location
Assessment & Training Setting
Antoineday
programrural dining room,
instructional room
Rickday
programrural dining room,
instructional room, hallway
Tonya workshop urban work areas, dining area
Settings
ASSESSMENT AND ANALYSIS
OF PROBLEM BEHAVIOR
Functional Assessment (FA) PURPOSE
Collect information
Background Information
Topography of problem behavior
Environmental variables
Develop Hypotheses
FA – Methods and Outcomes
INDIRECT METHODS
DIRECT METHODS
DefinitionsHypotheses
Temporal Relationships
Verify Hypotheses
Record Review
ABC observations(Bijou, Peterson, & Ault,
1968)
Interview(FAI; O’Neill et al., 1997)
Background information
FA - DTFA
Hypotheses
DTFA
Test Hypotheses
Develop DTFA
DTFA - Conditions
AttentionAutomatic
Reinforcement
AttentionTangible
1Tangible
2
AttentionTangibles
Antoine’s FA Hypotheses
Rick’s FA Hypotheses
Tonya’s FA Hypotheses
FA HYPOTHESIS
ANTECEDENT(No Access to Reinforcer)
CONSEQUENCE(Access to Reinforcer)
ASSESSMENT ( 2 min)
DTFA Components
REINFORCEMENT (2 min)
Present Antecedent STOP if:(a) problem behavior(b) time elapsed
Present Consequence hypothesized to maintain
problem behavior
+
DTFA - Protocols
AttentionAutomatic Reinforcement
AttentionTangible 1Tangible 2
AttentionTangibles
Antoine Rick Tonya
Target Behavior and Recording System
Problem Behavior No Response
TARGET BEHAVIOR
Occurrence or non-occurrence of the 2 responses (data sheet)Latency to first response
®WHO?
® researcher, staff member, or behavioral consultant
®WHEN?
® naturally-occurring opportunities during typical
routines throughout the day
®HOW?
® 1-5 trials per day under one or multiple conditions
® wait 10-15 min between trials
DTFA Implementation
ASSESSMENT
(No access to reinforcer)
REINFORCEMENT
(Access to reinforcer)
What Did We Anticipate?
Problem behavior
Few or No Problem behavior
RESULTS
Latency to Problem Behavior
Social Validity
WHO?
Staff Questionnaire End of assessment
HOW? WHEN?
OUTCOME – Information about:
Significance of outcomesAppropriateness of proceduresContinuation of procedures in the future
Social Validity
Easy to conduct (M=3.0)
SD (1) SA(4)D (2) A (3)
Procedures were clear
Interested in learning more
(M=3.5)Took a long time
(M=1.0)
Interfered with other
responsibilities (M=1.5)
DISCUSSION
® Clear patterns of behavior for all three participants
® Applicable to adults with dual diagnosis
® Few number of trials across conditions
® Variability in the topography of problem behavior and
number of trials with problem behavior
Effectiveness of DTFA
®Variations in stimulus control
® Individual motivation
® Fluctuation in the reinforcing value of certain
people, items, or activities
Factors That May Have Influenced Variability in the Topography of Problem Behavior and
Number or Trials with Problem Behavior
® Efficient and less intrusive way to determine the
function of problem behavior
® Guide the delivery of reinforcement during
intervention and increase tolerance for delayed
reinforcement
Latency to First Occurrence of Problem Behavior
® Implemented by staff members
® Embedded within typical routines
® Rated by staff members as:
® Easy to implement
® No time consuming
Social Validity
CONCLUSION
DTFA was effective in identifying the function of
problem behavior for all three adults
Conclusion
FUTURE STUDIES
Future research may include:
Staff training for implementation of DTFA
Replication of findings
FUNCTIONAL COMMUNICATION
TRAINING (FCT)
FCT
Identification of
replacement behavior
Teaching replaceme
nt behavior
STEPS
Identification of Functionally Equivalent Replacement Behavior
Reviewed DTFA results
Consulted with staff members
Identified a behavior that was easily discriminable
and functionally equivalent
Defined behavior
Constant time delay
Differential reinforcement
Error correction
Protocol
Teaching the Replacement Behavior
Develop Instructional Procedures
Provide Instruction and Progress Monitoring
Assess Current Level of
Performance
8 opportunitiesDaily routinesBehavioral indicationResearcher & staff
BASELINE Protocol and Data Sheet
INTERVENTION Protocol and Data Sheet
Target Behavior and Recording System
Prompted Response or Problem Behavior
Independent Response
TARGET BEHAVIOR
Occurrence or non-occurrenceof the two responses for each
opportunity (data sheet)
RESULTS
RESULTS
Discrimination Assessment
Identify Example and Non-Example Discrimination
Probes and Develop Protocol
Administer Probes and Collect Data
100% across all participants for both
example probes and non-example probes
Discrimination Probes
Social Validity
WHO?
Staff Questionnaire End of study
HOW? WHEN?
OUTCOME – Information about:
Significance of outcomesAppropriateness of proceduresContinuation of procedures in the future
Social Validity
PB affected QOL
(M=3.5)
Benefited from learning a new response and it
reduces the frequency of PB
Willing to continue the intervention
(M=3.0)
Easy to conduct (M=2.5)
Interfered with other
responsibilities (M=2.0)
SD (1) SA(4)D (2) A (3)
DISCUSSION
® Applicable to adults with dual diagnosis
® Mental illness may influence the
acquisition pattern of some adults with
dual diagnosis
® Effective in producing acquisition of a
replacement behavior for all three adults
Effectiveness of FCT
® Response competition
® Variations in stimulus control
® History of reinforcement
Factors That May Influence Different Acquisition Patterns
® Teach in the presence of behavioral indication
® Increases the likelihood of the precise use of
replacement behavior
Discriminated Use of the Replacement Behavior
® Implemented by staff members
® Embedded within naturally-occurring opportunities
® Rated as:
® Beneficial for participants
® Relatively easy to implement
® No time consuming
Social Validity
CONCLUSIONS
1. FCT produced acquisition of a functionally
equivalent replacement behavior
2. FCT produced discriminated use of the newly
acquired replacement behavior
Conclusions
FUTURE STUDIES
Future research may include
Relationship between behavioral indication and
generalization of replacement behavior
Staff training to identify teaching opportunities
Replication of findings
?