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Practical Functional Assessment
and Skill-Based Treatment of
Severe Problem Behavior
Presented by
Gregory P. Hanley, Ph.D., BCBA-D, LBA
2019
The Problem
• Problem behavior is prevalent among children with autism and is sometimes severe and intractable
• Many “solutions” often exacerbate or prolong the problem▫ Behavior modification
▫ Behavior medication
▫ Behavior mollification
▫ Behavior micro-analysis
▫ Behavior remediation without developing a replacement repertoire
A Probable Solution
• Practical Functional Assessment and Skill-Based Treatment▫ Shown to produce socially meaningful outcomes
▫ Shown to be a socially valid and generally applicable process
▫ Shown to be effective without coercion or physical management
Assumptions of Traditional Functional Assessment
An event evokes problem behavior
e.g., demand issued, toy removed, or attention diverted
An event reinforces problem behavior
e.g., escape, tangibles, or attention
Different forms of problem behavior are likely to be evoked and maintained by different reinforcers
Antecedent → Behavior → Consequence
Establishing operation → Problem Beh. → Reinforcement
Mom attends to Throwing toys Mom’s attention
Sibling
Dad instructs to SIB Dad gives a little turn off Ipad more time on Ipad
This is the “one thing at a time” model
Or the traditional model of relying on isolated reinforcement contingencies
Aim of Traditional Functional Assessment
To identify the function of a problem behavior
Attention,
Tangibles,
Escape, or
Sensory
Outcomes of Traditional Functional AssessmentThe good (based on published research)
-Standard analyses show control of problem behavior
-Standard analyses have generality
-Better treatment efficacy if preceded by a traditional analysis
Outcomes of Traditional Functional AssessmentThe unfortunate (based on published research)
-No treatment utility shown for closed-ended indirect or desc. assessments
-Traditional analyses: -have not yet yielded a socially meaningful treatment outcome, -are not being employed by practicing behavior analysts or others
Why?-take too long, -can be unsafe, -are not socially valid, -are not ecologically valid, -often do not control problem behavior enough
Past Working Assumption retained in the Practical Functional Assessment Process
ASSUMPTION: If problem behavior is occurring with regularity…..
▫ it is being reinforced Even when important biological/medical factors are known or suspected
Transition from traditional reductionist approach to a more pragmatic approach requires changes to
Assumptions, Aims, Procedures
A change is warranted
“New” Assumptions
Multiple events co-occur to evoke problem behavior
Multiple events occur simultaneously to reinforce (strengthen) problem behavior
Different forms of problem behavior by the same child are often maintained by the same synthesized reinforcement contingency
The “many things at a time” model of a reinforcement contingency:
Antecedents → Behaviors → ConsequencesEstablishing operations → Problem Behaviors → Reinforcers
Put away iPad → Noncompliance + → Avoidance of chores + to do chores resistance + continued time on iPad + (brother present) negotiating + choices +
screaming + undivided attentionflopping +slapping
*also known as a synthesized reinforcement contingency
The “many things at a time” TREATMENT model:
Antecedents → Behaviors → ConsequencesSame establishing → New Skills → Same reinforcersoperations
Put away iPad → “excuse me” → break from more chores+ to do chores Listens to parent time on iPad + (brother present) “May I have my way please” choices of activity +
“Okay, no problem” some undivided attnComplies with multiple
instructions and corrections
*involves the same synthesized reinforcement contingency
Similar effects reported in these studies from other research groups
The PFA process has strong and unprecedented treatment utility
(2014) JABA
(2016) Beh. Int.
Strand & Eldevik (2017) Beh. Int.
Herman, Healy, & Lydon (2018) Dev. Ne.
Jessel, Ingvarsson, Metras, Hillary, & Whipple (2018) JABA
Beaulieu, Clausen, Williams, & Herscovitch (2018) BAP
Taylor, Phillips, & Gertzog (2018) Beh. Int.
Rose & Beaulieu (2018) JABA
Baseline Treatment
0
2
4
6
N = 25
p < .001
Pro
ble
m b
ehav
ior
per
min
1 2 3 4 5 6 7
You found the recommended treatment acceptable
You are satisfied with the amount ofimprovement seen in problem behavior
You are satisfied with the amountof improvement seen in
communication skills
You found the assessment andtreatment helpful to your home situation
Notacceptable/satisfied/helpful
Highlyacceptable/satisfied/helpfulCaregiver Rating
Jessel, Ingvarsson, Metras, Hillary, & Whipple (2018, JABA)Achieving Socially Significant Reductions in Problem Behavior following the Interview-Informed Synthesized Contingency Analysis: A Summary of 25 Outpatient Applications
*Similar CCCSD evidence for any other functional assessment process does not exist.
Procedures*What is involved in a Practical Functional Assessment (PFA) process?
• An open-ended interview (always)
• An informal observation (perhaps, but not necessary)
• A functional analysis (always)
▫ An IISCA An Interview-Informed
Synthesized Contingency
Analysis
Example Case: Brandon
• Age: 3
• Diagnosis: None
• Language: Speaks in short sentences
• Referred for: Aggression, meltdowns,
noncompliance
• To: Life Skills Clinic
(outpatient model) at Western New England University
*Mission to identify:
1. the most concerning problem behavior and all other forms of problem behavior that co-occur in the same situations with (or prior to) the most concerning problem behavior
2. the events that seem to co-occur and reliably evoke problem behavior
3. the types of events and interactions that have occurred following problem behavior and are reported to stop the problem behavior
1. Hitting, kicking, biting, throwing objects, dropping to the floor while crying, refusing to follow parental instructions
2. Interrupting his play/game, removing toys (e.g., action figures), seeing others playing with his toys, adult noncompliance with mands, instructions to play differently, to play quietly on iPad, to sit quietly with books, or to clean up toys
3. Escape from parental instructions to his toys, parental attention/interaction, and mand compliance
The open-ended interview
Sessions1 2 3 4 5
Pro
ble
m B
ehav
ior
per
Min
ute
0
1
2
3
Control
Test
Escape to tangibles, attention, andmand compliance
Example IISCA: Brandon
All sessions are repeated at least once
Because replication is the key to believability (Baer, Wolf, & Risley, 1968)
Note:
There should be no problem behavior in the control sessions, if there is, either repeat or redesign
Sessions1 2 3 4 5
Pro
ble
m B
ehav
ior
per
Min
ute
0
1
2
3
Control
Test
Escape to tangibles, attention, andmand compliance
Example IISCA: Brandon
Notes:
Test sessions are repeated at least twice
Control and test sessions are alternated to evaluate whether suspected contingency influences problem behavior
An IISCAis an Interview-Informed Synthesized Contingency Analysis. It involves:
Test
Control
Analysis
• Provision of personalized and synthesized reinforcers for problem behaviors, reported to co-occur, in a single condition
• Provision of same reinforcers continuously in a second condition, otherwise matched
• Rapid alternation of these test and control conditions, which differ only by the presence/absence of the contingency
Diego / test session• Age: 11
• Diagnosis: Autism
• Language Level: Speaks in Short Sentences
• Referred for: Self-injurious behavior,Aggression, Property Destruction
Sessions1 3 5
Pro
ble
m B
ehav
ior
per
Min
0.0
0.5
1.0
1.5
2.0
Control
Test
Diego
Escape from academic work to
tangibles, attendion
*Why bother with analysis? Why spend time? Why invite the risk?
Because it gives the practitioner:
• a context to demonstrate whether they can safely influence problem behavior
• a scientific verification of the hypothesis from the interview
• a properly motivating set of conditions to teach important life skills
And the teaching of these skills is the key to a meaningful life
Aim of a Practical Functional Assessment
*NOT to identify the function of a problem behavior*
Aim is strong control of problem behavior
via ecologically-relevant reinforcement contingency
From Jessel, Hanley, & Ghaemmaghami (JABA, 2016)
0
4
8
12Will
TestControl
Wayne Allen Kat (Cxt 1)Sam
0
2
4
6Jack (Cxt 1) Keo
Kristy Jim
Roxy
0
2
4
6Alex (Cxt 2) Chris
Jeff Zeke Kat (Cxt 2)
0
1
2
3
4 Mike Mitch
Gary Jian Earl
0.5
1.0
1.5
2.0
0
Paul Dan
Alex (Cxt 1) Beck
Sid
2 6 10
0.5
1.0
1.5
2.0
0
Lee
2 4 6
Steve
1 3 5
Jesse
1 3 5
Carson
1 3 5
Jack (Cxt 2)
Sessions
Pro
ble
m b
ehav
ior
per
min
From Rajaraman, Hanley, et al. (in prep.)
Pro
ble
m b
ehav
ior
per
min
ute
Sessions
Strong control of problem behavior is paramount and evident in IISCAs
Sessions
1 2 3 4 5
Pro
ble
m B
ehav
ior
p
er M
in
0
1
2
3
ControlTest
Session 2
Reinforcement
Problem Behavior during Establishing Operation Problem Behavior during Reinforcement
Seconds
0 50 100 150 200 250 300
Session 5
Session 4
BrandonEscape to attention,tangibles, andmand compliance
Sessions1 2 3 4 5
Pro
ble
m B
ehav
ior
per
Min
ute
0
1
2
3
Control
Test
Escape to tangibles, attention, andmand compliance
Strong control of problem behavior is paramount and evident withinIISCA test sessions
Typical Aggregate Display
Intimate Display of Test Sessions
Why is strong control over problem behavior important to obtain in a pre-treatment functional analysis?
Implications of strong control of problem behavior
You can turn off problem behavior = analysis informed treatment process can be safe & effective
You can turn on problem behavior = skills may be developed in treatment
With an ecologically relevant contingency = problem behavior reductions and skills
may transfer to relevant context
Isolated contingencies sometimes do not control behavior whereas synthesizedcontingencies do.
This is not a paradox, just a classic example of an interaction without main effects
0
1
2
3
4
Tangible /
Attention
Analyst
Mother
Analyst
Mother
Analyst
Gail
Pro
ble
m B
ehav
ior
per
Min
0
1
2
3
4
Tangible
Sessions
2 4 6 8 10 12 14
0
1
2
3
4
Test
Control
Meltdowns
Col 46 Attention
Case Example Gail, 3 yo, dx: PDD-NOS
Setting: Clinic
Synth
esizedIso
lated Iso
latedFrom Hanley et al., 2014, JABA
0
1
2TestControl
Escape to tangiblesand attention
Tangible
Ignore/Alone
PlayEscape
Attention
0
1
2
3Escape to tangiblesand attention
1 2 3 4 5
0
1
2
3Escape totangibles
5 10 15
0
2
4 Escape totangiblesand attention
Diego
Mason
Riley
Pro
ble
m b
ehav
ior
per
min
Sessions
IISCA Standard IISCA
From Slaton et al., 2017, JABA
Most often, our comparative analyses show that synthesized reinforcement contingencies influence problem behavior whereas isolated ones do not
Synthesized Isolated Synthesized
Whole contingencies have properties that sometimes cannot be found in the parts of the contingency
Single tests of individual reinforcers are not capable of verifying the irrelevance of synthesized reinforcers
Treatment Comparison Results
0
1
2
3
4
5
FCR
BL FCT + EXT
Escape totangibles,attention
Problembehavior
BL FCT + EXT
Escape
5 10
0
1
Escape totangibles
BL FCT + EXT
5 10
Attention
BL FCT + EXT
IISCA- based treatment Standard-based treatment
Pro
ble
m b
ehav
ior
per
min
Sessions
Emily
Jeff
(From Slaton et al., 2017, JABA)
Comparative treatment analyses reliably reveal advantage of synthesized contingenciesFrom:
NATURE AND SCOPE OF SYNTHESISIN FUNCTIONAL ANALYSIS AND TREATMENT OF PROBLEM BEHAVIOR
Slaton & Hanley (JABA, 2018)
10 20 30 40 50 60 70 80
-500
-100
-80
-60
-40
-20
0
20
40
60
80
100
Synthesized Isolated
Within-subject comparisons Applications without comparisons
Treatment applicationsM
ean
b
asel
ine
red
uct
ion
(%
)
Synthesized contingencies had a better effect size in 25 of 26 cases (96%)
EO Sr
R
With single reinforcers, there is relatively short motivational distance travelled as child transitions from:
no skittle sliver to having a skittle sliver , or
work to no work , or
no attention to attention (reprimands)
*that’s one interpretation
EO Sr
R
EOEOEOEO Sr Sr Sr Sr
With IISCA, there is relatively long motivational distance travelled as child transitions from:
No tangibles, no mand compliance, tangibles, mand compliance,
limited sensory reinforcers, to all sensory reinforcers,
no high quality attention, & work high quality attention, and no work
EO Sr
R
EOEOEOEO Sr Sr Sr Sr
With IISCA, there is relatively long motivational distance travelled as child transitions from:
But, don’t forget about possible interactions:
which probably creates even greater motivational distance travelled
Lev
el of C
oncern
Acro
ss
Top
ogra
ph
ical C
ateg
ories
Level of Concern
Within
Topographical Categories
Self
inju
ryA
ggressio
n Scream
ing
Body
Ten
sing
(MC
T)
(AL
CT
)(MCT) (ALCT)
This schematic provides a visual
display of a possible repertoire of
problem behavior whose
members were reported by
caregivers as co-occurring in the
same evocative situations. If the
primary concern of the caregivers
is high-intensity head banging, a
behavior analyst must then decide
on the contingency class for their
functional analysis, weighing the
factors of risk, efficiency, and
inference.
Level
of C
oncern
Acro
ss To
po
gra
ph
ical
Ca
teg
orie
s
Selfinjury
Aggression
Screaming
BodyTensing
(Mo
st)(L
ea
st)(M
ost)
(Lea
st)
Level of Concern
Within Topographical Categories
(Most) (Least) (Most) (Least)
A B
C D
Selfinjury
Aggression
Screaming
BodyTensing
Select the responses to be consequated in analysis:
A
B
C or
D ?
That which you can safely infer from your functional analysis:
✓Response class membershipProblem Behaviors reported to co-occur (in order of concern)A. SIBB. AggressionC. Disruptive BehaviorD. Disruptive vocalizationsE. Whining/complaining
If control is shown over behavior E, for example, and caregivers report that behavior A, B, C, D, & E co-occur in similar situations, then we can infer that the reinforcers for behaviors A and E are the probably same
Problem Behaviors reported to co-occur (in order of concern)A. SIBB. AggressionC. Disruptive BehaviorD. Disruptive vocalizationsE. Whining/complaining
Problem Behaviors reported to co-occur (in order of concern)A. SIBB. AggressionC. Disruptive BehaviorD. Disruptive vocalizationsE. Whining/complaining
This analysis shows all forms of problem behavior are influenced by the same synthesized reinforcement contingency.
This happened for 9 of 10 consecutive analyses (Warner et al., 2018)
This also happens when others conduct progressive extinction analyses (Smith and Churchill,
2002, Borrero & Borrero, 2008, Herscovitch et al., 2009)
Which is why it is a reasonable thing to make inferential leap.
Conducting low inference analyses
of severe problem behavior is
inefficient,
potentially dangerous,
and difficult to defend at this point
Consider also that:
Safety
Safety is primarily insured through:
• Immediate delivery
• Of all suspected reinforcers
• For any member of the response class
(an “open” contingency class)
in test conditions
• Continuous access to all reinforcers
in control conditions.
Other safety considerations:
• Salient cues for EO and SR intervals
• Everybody has session termination authority
Risk
Risk is primarily invited through:
• Delayed delivery
• Of one/some of the suspected reinforcers
• For a single member of the response class (a “closed” contingency class)
in test conditions
• Discontinuous access to all reinforcers
in control conditions.
Other safety considerations:
• Ambiguity regarding EO and SR intervals
• Only supervisor has session termination authority
Important point to consider…
Children/clients should appear happy, relaxed, and engaged during reinforcement periods of analyses (and prior to each session start)
Interviewer attempts to build rapport with parents/teachers while identifying:
1. ??
2. ??
3. ??
The open-ended interview
General Tips:
• Interview those who spend the most time with the child/client and who witness the PB the most.
• Interview people together as needed (no separate interviews), develop consensus, and if not, just move forward (i.e., design an analysis).
• Start by asking for vivid recounting of episodes of severe problem behavior then ask hypotheticals and restrictions
• Be sure to ask about specific materials for the analysis that allow for the programming of the EOs and SRs.
The IISCA Task Analysis
Implement CONTROL session first
If zero PB in control, conduct TEST session next
Gain Assent
Analyze as you conduct sessions; be responsive to the data
Design checkIs the distinction between the EO and SR ridiculously salient?
Tables, Mat and Table, Bins, Trays, Analyst body position, tone of voice
Is the motivational distance travelled long? Can it be longer?Add more positive reinforcers, strengthen EO for escape, ….
Are there at least 3 sets of materials in the EO and SR areas?
Is there anything about the space or materials that may lead to injury?
Is there enough space for movement? Are there activities to evoke mands?
Is there anything more reinforcing in the building but not in the analysis space?
Is the importance of happy, relaxed, and engaged fully embraced?
Diego / treatment session*The skills of functional communication,
delay/denial toleration, and contextually appropriate behavior are shaped via
intermittent and unpredictable delivery of the same synthesized reinforcers during the same
synthesized establishing operations.
Effects are extended to relevant people implementing in relevant contexts over relevant time periods.
Effects are socially validated.
• Age: 11
• Diagnosis: Autism
• Language Level: Speaks in Short Sentences
• Referred for: Self-injurious behavior,Aggression, Property Destruction
Functional communicationrequest (FCR)
DeniedTolerance
response (TR)
Variable amount of work/playexpectations
Compliance
ReinforcementGranted
20%
60%
What is the treatment????
Intermittent and unpredictable reinforcement of life skills:
Functional CommunicationDelay/denial tolerationCompliance
Treatment Implementation
*Materials not needed: Laminate Laminating machineGlue gunsVis a vis markersVelcroTokensToken boardsTimersStickersCandiesAnything that was not already in
the child’s environment!
1. Put these in your pocket2. Pull one out while child is experiencing their reinforcers3. Keep it to yourself4. Require that behavior next time
✓The treatment is implemented in the most challenging context that is sufficiently convenient to repeatedly arrange
▪ Referred to as the “two Cs” of context
▪ FIRST THINGS FIRSTDistinct contextually appropriate behavior is shaped in the other relevant contexts only following success in the initial context
Brandon / Simple FCT• Age: 4
• Diagnosis: None
• Language Level: Speaks in Short Sentences
• Referred for: Aggression, Meltdowns, Noncompliance
Co
mp
lex
FC
R p
er m
in
0
1
2
3
C
on
tex
tual
lyA
pp
rop
riat
e B
ehav
ior
(%)
0
25
50
75
100
Sim
ple
FC
R p
er m
in
0
1
2
3
Pro
ble
m B
ehav
ior
p
er m
in
0
1
2
3
Context A- Analyst 1Context B- Analyst 2Context A- Analyst 3
To
lera
nce
Res
po
nse
p
er m
in
0
1
2
3
Sessions
5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80
Du
rati
on
of
sess
ion
(
s)
0
100
200
300
400
500
600
in Reinforcementin Establishing Operation
Baseline Simple BL Simple Complex Tolerance response Contextually appropriate behavior Transfer
FCT FCT FCT training chaining test
Brandon
TIPS:
1. Select initial FCRs that are:Low effortPromptableNovelOmnibus
2. Initially prompt prior to when PB was evoked in the analysis.
3. If PB occurs, prompt the FCR and reinforce the prompted response
*See page 2 of SBT Notebook
Brandon / Complex FCT• Age: 4
• Diagnosis: None
• Language Level: Speaks in Short Sentences
• Referred for: Aggression, Meltdowns, Noncompliance
Co
mp
lex
FC
R p
er m
in
0
1
2
3
C
on
tex
tual
lyA
pp
rop
riat
e B
ehav
ior
(%)
0
25
50
75
100
Sim
ple
FC
R p
er m
in
0
1
2
3
Pro
ble
m B
ehav
ior
p
er m
in
0
1
2
3
Context A- Analyst 1Context B- Analyst 2Context A- Analyst 3
To
lera
nce
Res
po
nse
p
er m
in
0
1
2
3
Sessions
5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80
Du
rati
on
of
sess
ion
(
s)
0
100
200
300
400
500
600
in Reinforcementin Establishing Operation
Baseline Simple BL Simple Complex Tolerance response Contextually appropriate behavior Transfer
FCT FCT FCT training chaining test
Brandon
TIPS:
Shape until FCR contains:
An obtaining a listener response (e.g., “Excuse me”)
A generative autoclitic frame (e.g., “May I have _____”)
A social nicety
Proper tone, pace, volume, articulation
See Ghaemmaghami et al. (JABA, 2018)
*See page 2 of SBT Notebook
FCT – RajAge: 5 Diagnosis: Autism Language Level: Single word utterances Referred for: Self-Injury, Aggression, Property Destruction
TIP:
Or at least be sure the cFCR has some “intentionality”
FCT – ColeAge: 8 Diagnosis: Autism Language Level: Fully Fluent Speech Referred for: Self-Injury, Aggression, Property Destruction
But once FCR is shaped until it contains:
An obtaining a listener response (e.g., “Excuse me”)
A generative autoclitic frame (e.g., “May I have _____”)
A social nicety
Proper tone, pace, volume, articulation
…..
FCT – ColeAge: 8 Diagnosis: Autism Language Level: Fully Fluent Speech Referred for: Self-Injury, Aggression, Property Destruction It is sometimes
differentiated into specific mands prior to tolerance training:
• An obtaining a listener response
• A break response
• An access to preferred toys response
• An attention recruitment response
Brandon / TRT• Age: 4
• Diagnosis: None
• Language Level: Speaks in Short Sentences
• Referred for: Aggression, Meltdowns, Noncompliance
Co
mp
lex
FC
R p
er m
in
0
1
2
3
C
on
tex
tual
lyA
pp
rop
riat
e B
ehav
ior
(%)
0
25
50
75
100
Sim
ple
FC
R p
er m
in
0
1
2
3
Pro
ble
m B
ehav
ior
p
er m
in
0
1
2
3
Context A- Analyst 1Context B- Analyst 2Context A- Analyst 3
To
lera
nce
Res
po
nse
p
er m
in
0
1
2
3
Sessions
5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80
Du
rati
on
of
sess
ion
(
s)
0
100
200
300
400
500
600
in Reinforcementin Establishing Operation
Baseline Simple BL Simple Complex Tolerance response Contextually appropriate behavior Transfer
FCT FCT FCT training chaining test
Brandon
*See page 2 of SBT Notebook
Brandon / CAB Chaining• Age: 4
• Diagnosis: None
• Language Level: Speaks in Short Sentences
• Referred for: Aggression, Meltdowns, Noncompliance
Co
mp
lex
FC
R p
er m
in
0
1
2
3
C
on
tex
tual
lyA
pp
rop
riat
e B
ehav
ior
(%)
0
25
50
75
100
Sim
ple
FC
R p
er m
in
0
1
2
3
Pro
ble
m B
ehav
ior
p
er m
in
0
1
2
3
Context A- Analyst 1Context B- Analyst 2Context A- Analyst 3
To
lera
nce
Res
po
nse
p
er m
in
0
1
2
3
Sessions
5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80
Du
rati
on
of
sess
ion
(
s)
0
100
200
300
400
500
600
in Reinforcementin Establishing Operation
Baseline Simple BL Simple Complex Tolerance response Contextually appropriate behavior Transfer
FCT FCT FCT training chaining test
Brandon
Wicked important tips when developing Contextually Appropriate Behavior (CABs)
1. Start by gaining instructional control over relinquishing positive reinforcers.
*See pages 2-3 (planning sheets),
10-13 (implementation/data sheets)
of SBT workbook
*See pages 2, 10 of SBT workbook
7. Describe the initial contextually appropriate behaviors (CAB 1). These are the
behaviors that will be instructed following tolerance responses and strengthened via the
termination of the delay (i.e., access to the synthesized reinforcers).
CAB 1: Instructional control of stopping ongoing activity & relinquishing all positive
reinforcers
Example:
a) “Pause the game please.”
b) “Hand me the iPad.”
c) prompt or wait for the look to you
Wicked important tips when developing Contextually Appropriate Behavior (CABs)
1. Start by gaining instructional control over relinquishing positive reinforcers.
2. Then gain instructional control over transitioning and readying to listen/learn
*See pages 3, 10 of SBT workbook
CAB 2: Instructional control of transitioning to
alternative area and readying to listen/learn
a)
b)
c)
d)
Examples:
To table-top academics:
a) stand up
b) walk to that table
c) sit up in the chair
d) hand in lap
To participate in gym games:
a) turn to me
b) walk over there
c) get ready like this
(model stance)
To play alone:
a) stand up
b) walk over there
c) take a seat
Wicked important tips when developing Contextually Appropriate Behavior (CABs)
1. Start by gaining instructional control over relinquishing positive reinforcers.
2. Then gain instructional control over transitioning and readying to listen/learn
3. Then gradually increase the average amount of behavior (not just time) required to terminate the delay
*See page 3, 11-12 of SBT workbook
CAB 3: Instructional control of a few (1-3) responses/time
units of cooperation within a single, relevant activity
Activity:
Examples:
To table-top academics:
a.) Show me the ____
b.) Show me the ____
c.) Show me the ____
To participate in gym games:
a) Catch
b) Throw to me
c) Put ball in basket
To….
CAB 4: Instructional control of a few (1-3) responses/time
units of cooperation within multiple relevant activities
Activity:
Activity:
Activity:
CAB 5: Instructional control of 1-12+ responses/time units of
cooperation w/in multiple activities
Consider this progression from 1, 2, 3:
a. 1, 3, 5
b. 1, 3, 6, 10
c. 1, 3, 6, 10, 12+
Wicked Important Guidelines when Developing Contextually Appropriate Behavior (CABs)
1. Start by gaining instructional control over relinquishing positive reinforcers.
2. Then gain instructional control over transitioning and readying to listen/learn
3. Then gradually increase the average amount of behavior (not just time) required to terminate the delay
4. Terminate the delay for various amounts of behavior (sometimes expect very little behavior sometimes request larger or more complex types of behavior during the delay)
Wicked Important Guidelines when Developing Contextually Appropriate Behavior (CABs)
1. Start by gaining instructional control over relinquishing positive reinforcers.
2. Then gain instructional control over transitioning and readying to listen/learn
3. Then gradually increase the average amount of behavior (not just time) required to terminate the delay
4. Terminate the delay for various amounts of behavior (sometimes expect very little behavior sometimes request larger or more complex types of behavior during the delay)
5. Probably best to not signal how much behavior or what type of behavior is required to terminate the delays
*See pages 3, 13 of SBT workbook
CAB 6: Instructional control of 1-12+ responses/time units of
cooperation w/in multiple activities while being challenged
Examples:
a) Require more complex/conditional discrimination
b) Interrupt correct performance
c) Change activity or rules of activity
d) Require completion in new, different way
e) Issue vague instructions
f) Program for missing items from task
g) Introduce unknown tasks
In case it is not apparent:
Shorties never go away.
This is the way we keep hope alive!
Shaping Models
Light dosage approaches (approx. 8-12 weeks to full day treatment)
Implementation by BCBA: at least 1hr/day for 4/days week
Collaborative approach: Implementation by 1 parapro/staff at least 1hr/day for 4/days week
High dosage approaches (approx. 1-3 weeks to full day treatment)
Implementation by BCBA: 4-5hrs/day for 5/days week
Collaborative approach: Implementation by 1 parapro/staff 4-5 hrs/day for 5/days weekwith two daily 30 min check-ins by BCBA for 4 days/week
* requires consideration of out-of-session programming: (a) business as usual or (b) NCR
Take Home Point: What is required for a Meaningful Outcome?
Personalized & Synthesized Reinforcement Contingencies
and
a progressively developing, skill-Based treatment process thatrelies on unpredictable and intermittent reinforcement to maintain effects
Limitations of the PFA process
General and durable elimination of severe problem behavior is still elusive for some following successful PFA processes
▫ Developing a replacement repertoire requires time, expertise or expert supervision, and the ability to problem solve as skills are developed
▫ Transferring positive effects from one or a few people and one or a few contexts to all people and all contexts is still a formidable challenge
▫ Methods require adjustment to expand scope of practice
Recent Extensions of the PFA process
1) Expanding Reach with the Enhanced Choice Model
(Rajaraman, Hanley et al., in review)
2) Skill-Based Treatment of Interfering Stereotypy (Slaton, Hanley, Ruppel, & Gage, in review)
Extinction sometimes, but consider….
Okay Alternative to Full Extinction:
Partial Extinctionescape always available
PB = escape to nothing vs.
Skills = escape to everything
The Enhanced Choice ModelHangout Context
Treatment
(Contingent SR)
No EOs
(NoncontingentSR)
Return to Home or classroom
Enhanced Choice Model
Practice Context
• Similar outcomes in similar time frames• No escalation to severe problem behavior• Allowed expansion of clients served
Why would children choose to participate in treatment?
Partly due to the universal preference for contingent over noncontingent reinforcers
(i.e., due to a preference for yearning and earning)
ContingentReinforcement
Blue Switch
Red Switch
White Switch
FR-1
NoncontingentReinforcement
NoReinforcement
Response Contingent Attention (FR-1)
NoncontingentAttention (yoked)
No Attention Available
Initial Link Terminal Links
2 min period:
2 min period:
2 min period:
FromHanley, Piazza, Fisher, & Contrucci, 1997, JABA
1 2 3 4 5 6 7
Num
ber
of
Sw
itch
Pre
sses
0
2
4
6
8
10
FCTNCREXT
Tony
1 2 3 4 5 6 7 8 9
Nu
mb
er o
fS
wit
ch P
ress
es
0
2
4
6
8
10
Carla
Sessions
Preference for contingent over noncontingent
reinforcement
FromHanley, Piazza, Fisher, & Contrucci, 1997, JABA
CRNCREXT
% o
f re
spond
ing
allo
cate
d t
o c
ont
inge
nt r
einf
orc
emen
t
0
25
50
75
100
Preferred Indifferent Did not prefer
71% of individuals
n = 96
20
5696
20 8040 20
40
40
20
11
20
15
57% of aggregates
preferred contingent reinforcement
120
Preference for contingent reinforcement has generality
Literature Review:Gover & Hanley (in prep.)
Analysis - Jeffrey• Age: 9
• Diagnosis: Attention Deficit Hyperactivity Disorder, Generalized Anxiety Disorder
• Language Level: Speaks with Sophistication
• Referred for: Aggression, Elopement, Meltdowns
▫ required several police escorts from school
Test (later session on same day)
LIFE SKILLS CLINICAT WESTERN NEW ENGLAND UNIVERSITY
Sessions1 2 3 4 5 6
Pro
ble
m B
ehav
ior
per
Min
0
2
4
6
8
ControlTest
Escape to tangibles,
attention, and
mand compliance
Modifications to Hanley et al. (2014)
1. General transparency on day’s activities
2. Choices offered during CAB chaining• Dunlap et al., 1994; Moes, 1998; Powell & Nelson, 1997
3. Extinction of problem behavior never involved physical guidance of any sort• Piazza, Moes, & Fisher, 1996
4. Choice to hangout or leave always available
Practice Context
TREATMENT- Jeffrey
LIFE SKILLS CLINICAT WESTERN NEW ENGLAND UNIVERSITY
Sim
ple
FC
R
per
min
0
1
2
Pro
ble
m B
ehav
ior
per
min
0
2
4
6
8
Context A - Analyst 1
Context B - Analyst 2
Context A - Analyst 3
Context A - Analyst 4
Com
ple
x F
CR
per
min
0
1
2
Tole
rance
Res
ponse
p
er m
in
0.0
0.5
1.0
Sessions
5 10 15 20 25 30 35 40 45 50 55 60
Dura
tion o
f se
ssio
n
(s)
0
300
600
900
1200
1500
1800
2100
2400
in Reinforcement
in EO
Com
pli
ance
(
%)
0
25
50
75
100
Baseline Simple Complex Contextually appropriate behavior TransferFCT FCT TRT chaining test
Jeffrey
* * *
* Terminated session
* *
Results - Allie
1----------------2----------------3-----------4---------5---------6-------------7--------8------9----------10------11----12---13
BL Complex
TR
per
min
0.0
0.2
0.4
0.6
0.8
1.0
Tolerance Response Training
Sessions10 20 30 40 50
Dura
tion o
f se
ssio
n
(s)
0
300
600
900
1200
Reinforcement Establishing Operation
BL
Visits
Tota
l m
inute
s of
ther
apy
0
30
60
90
120
Practice
Hang out
Simp.
CA
B
(%
)
0
25
50
75
1002
4
5 61 3
Contextually Appropriate Behavior Chaining
FCT
5/7-------------5/9-------------5/16-----5/17-----5/21-----5/23----------6/4-----6/5----6/6--------6/8-----6/18---6/19--6/20
Dates
F
CR
per
min
0.0
0.5
1.0
1.5
2.0
Simple
Complex
Pro
ble
m B
ehav
ior
per
min
0.0
0.5
1.0
1.5
2.0Simp.
Allie
Level Demands related to playing,
doing something the adults
way, or cleaning up
Frequency/
Duration
Examples
1 Discrete demands 1-3 demands Put the stickers in the
bag, put the block in the
box
Make the frog jump, put
a sticker on my paper
2 Continuous demands Avg. 60 s
45 s
5 s
35 s
Go clean up the blocks
Let’s play with the
dinosaurs
3 Mix of discrete and continuous
demands
6 demands,
Avg. 120 s
Same as above,
longer durations
4 Mix of discrete and continuous
demands
+ sharing items she is playing
with
6 demands,
Avg. 180 s
Same as above,
longer durations +
asking her for a turn
with what she is playing
with.
5 Mix of discrete and continuous
demands
+sharing
+playing with something else
6 demands,
Avg. 240 s
Same as above +
sharing +
playing with something
else while other plays
with her toy
6 Mix of discrete and continuous
demands
+sharing
+playing with something else
+letting others go first
Avg. 300 s
Results - Allie
1----------------2----------------3-----------4---------5---------6-------------7--------8------9----------10------11----12---13
BL Complex
TR
per
min
0.0
0.2
0.4
0.6
0.8
1.0
Tolerance Response Training
Sessions10 20 30 40 50
Du
rati
on o
f se
ssio
n
(s)
0
300
600
900
1200
Reinforcement Establishing Operation
BL
Visits
Tota
l m
inute
s o
f th
erap
y
0
30
60
90
120
Practice
Hang out
Simp.
CA
B
(%
)
0
25
50
75
1002
4
5 61 3
Contextually Appropriate Behavior Chaining
FCT
5/7-------------5/9-------------5/16-----5/17-----5/21-----5/23----------6/4-----6/5----6/6--------6/8-----6/18---6/19--6/20
Dates
F
CR
per
min
0.0
0.5
1.0
1.5
2.0
Simple
Complex
Pro
ble
m B
ehav
ior
per
min
0.0
0.5
1.0
1.5
2.0Simp.
Allie
Socially validated outcome in13 1-hour visitsacross 6 weeks(>95% of time in treatment)
Results - Allie
1--------3---------5------------7-----------------9---------11---------13---15----17--------19--21----23---25---27---------29
Visits
Tota
l min
utes
of
ther
apy
0
15
30
45
60
75
90
105
120
Practice
Hang out
6/15----6/19-----6/26-------6/29-----------7/06--------7/12------7/19-7/26-7/31----8/07-8/10-8/16-8/21-8/24-----8/28
Dates
Socially validated outcome in29 1-hour visitsacross 10 weeks(>90% of time in treatment)
Recent Extensions of the PFA process
1) Expanding Reach with the Enhanced Choice Model
(Rajaraman, Hanley et al., in review)
2) Skill-Based Treatment of Interfering Stereotypy (Slaton, Hanley, Ruppel, & Gage, in review)
Skill-Based Treatment Applied to Interfering Stereotypy(Distance-Support Model)
S-
Stereotypy blocked
Mand for stereotypy
20%
DeniedTolerance response
Variable work/play
60%
S+
Stereotypy is allowed
15 – 45 seconds
Compliance
20%
Participants
Name Age Diagnosis Communication Work tasks
Grant 7 Autism 1-2 word phrases Numbers, letters, sight words, pictures, matching
Milo 12 Autism No phrases Match and identify objects, pictures, numbers, letters;
short ADL tasks
Marco 21 Autism 1-3 word phrases Leisure and time management on iPad
Stereotypy types
Grant Milo Marco
• Hand flapping• Finger wiggling• Object flapping• Clapping• Holding objects to
eyes and rotating
• Hand flapping• Tapping on teeth• Rubbing or poking face• Finger play• Shaking objects• Tapping work materials
• Pacing or galloping• Jumping• Tapping body, furniture• Hair twirling• Knuckle cracking
0
25
50
75
100
0
5
10
15
20
BL
S-S+
FCT TRT Response ChainingM
oto
r
ster
eoty
py
% o
f co
mpone
nt
S- d
uratio
n (min)
0
5
10
15
20
Sim
ple
F
CR
per
min
0
2
4
6
15
Com
ple
x F
CR
per
min
0
2
4
6
TR
per
min
20 40 60 80 100
0
25
50
75
100
0
20
40
60
801 2 3 4 7 5 6 7 8 94 10
Milo
Sessions
Acc
ura
cy (
%) #
dem
ands
Level Task Demandrange
Total demands
Field size
1 Match pictures 1 - 3 12 3
2 +Letters, numbers 1 - 3 12 3
3 (Same) 1 - 6 18 3
4 (Same) 1 - 10 27 3
5 (Same) 1 - 10 27 4
6 (Same) 1 - 10 27 5
7 (Same) 1 - 10 27 6
8 +Sort objects 1 - 10 27 6
9 +ADLs 1 - 10 27 6
10 +Identify pictures 1 - 10 27 6
Treatment: Intermittent and unpredictable delivery of escape and access to stereotypy for communication, toleration, and for ACCURATE work completion while inhibiting stereotypy
Five Hidden Themes Exposed
1. Have professional humility
2. Hold high expectations for your clients
3. Trust the universal preference for “yearning and earning”
4. Know that “free to be and do but not alone” is important
5. Craft your whole process to be televised
The Problem• Problem behavior is prevalent among children with autism and is
sometimes severe and intractable, leading to highly restrictive lifestyles, stunted skill development, or both.
A Potent Solution• Practical Functional Assessment (PFA) and Skill-Based Treatment (SBT)▫ Shown to produce socially meaningful outcomes▫ Shown to be a socially valid and generally applicable process▫ Shown to be effective within an Enhanced Choice Model
Important for use with adults or high-risk clients
Thanks for listening.
For implementation assistance go to:
www.practicalfunctionalassessment.com
Facebook: “BCBAs using the IISCA”
www.ftfbc.com