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Toward Meaningful Outcomes from Dignified Processes

A Tutorial on the Practical Functional Assessment Process for Problem Behavior

For more information go to:

www.practicalfunctionalassessment.com

Gregory P. Hanley Ph.D., BCBA-D

Seminar for: August, 2018

National Autism ConferencePenn State University

With Autism, there is a higher likelihoodof problem behavior likemeltdowns, aggression, and self-injury

Why do restricted “lifestyles” dictated by problem behavior

persist for many familieswith children on the spectrum?

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Restrictive lifestyles persist partly because problem behavior of children is merely

modifiedmedicated

mollified micro-analyzed

remedied apart from skill development

Powerful working assumption

If problem behavior is occurring with regularity…..

– it is being reinforced

(Even when important biological/medical factors are known or suspected.)

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The one thing at a time model

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

The one thing at a time model:

An Antecedent A Behavior A Consequence

An Establishing A Problem Behavior A Reinforceroperation

The shift to the many things at a time model:

Antecedents Behaviors Consequences

Establishing Problem Behaviors Reinforcersoperations

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The one thing at a time model:An Antecedent A Behavior A ConsequenceAn Establishing operation A Problem Behavior A Reinforcer

The many things at a time model:

Antecedents Behaviors ConsequencesEstablishing Problem Behaviors Reinforcersoperations

Put away iPad Noncompliance + Avoidance of chores + to do chores resistance + continued time on iPad +(brother present) negotiating + choices +

screaming + undivided attentionflopping +slapping

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

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Dignified processes and meaningful outcomes may be achieved when it is assumed that

1. Multiple establishing operations are usually influencing problem behavior and doing so simultaneously

2. Multiple reinforcers simultaneously maintain most problem behavior i.e., problem behavior is multiply controlled and usually controlled by at least escape to tangibles, attention, & either sensory reinforcers, mandcompliance, or both

– The trick is to determine the details within these generic categories that are relevant to each person

3. Most problem behavior emitted by the same person is sensitive to the same synthesized reinforcement contingency

Functional assessment is a process to determine the variables influencing problem behavior

Functional analysis is an attempt to model the natural conditions in which problem behavior is evoked and reinforced.

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“All models are wrong;

some are useful.”

Box & Draper, 1987, p. 424

Functional Assessment Process

Functional Analysis*IISCA

Indirect Assessment *Open-ended interview

Descriptive Assessment*Single, brief observation

Discovery Demonstrationand

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Traditional

Functional

Analysis

Multiple test conditions

Uniform test conditions

Isolated test contingencies

Reinforce dangerous behavior

Toy-play control condition

Interview-Informed

Synthesized Contingency

Analysis

Single-test condition

Individualized test conditions

Synthesized contingencies

Reinforce precursors to and

dangerous behavior

Test-matched control

Case Example: Gail, 3 years old, PDD-NOS

Interview suggested that Gail engaged in meltdowns and aggression….

when Mom was attending to other tasks or people….

in order to gain Mom’s undivided attention and to have Mom play with her and her most preferred toys.

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Functional Analysis: Control Condition

Control: Mom directs her undivided attention to Gail while interacting with her and her most preferred toys the entire time.

Gail

Sessions

1 2 3 4 5 6

Pro

ble

m B

ehav

ior

per

min

ute

0

1

2

3

4

Control

Test

In the control, we are emulating the conditions Mom described as being associated with no problem behavior.

Functional Analysis: Test Condition

Test: Mom attends to other tasks and people….

As soon as Gail engaged in any problem behavior, Mom directs her undivided attention to Gail while interacting with her and her most preferred toys.

Gail

Sessions

1 2 3 4 5 6

Pro

ble

m B

ehav

ior

per

min

ute

0

1

2

3

4

Control

Test

In the test, we are emulating the conditions Mom described as being associated with Gail’s problem behavior.

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Case Example: Gail, 3 years old, PDD-NOS

By alternating between 5 minute periods of test and control conditions, we were able to turn on and off Gail’s problem behavior….

Giving us and her Mom confidence as to why she was engaging in the extraordinary problem behavior

….to simply gain and maintain her Mom’s undivided attention and play time

Gail

Sessions

1 2 3 4 5 6

Pro

ble

m B

ehav

ior

per

min

ute

0

1

2

3

4

Control

Test

Safety is Paramount

Safety is primarily insured through:

Immediate delivery

Of all suspected reinforcers

For any member of the response class

(use relatively open response classes; Warner et al., 2018)

Other safety tactics

Body position

Everybody with session termination authority

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IISCA - Brandon• Age: 3

• Diagnosis: None

• Language Level: Speaks in Short Sentences

• Referred for: Aggression, Meltdowns,

Noncompliance

LIFE SKILLS CLINICAT WESTERN NEW ENGLAND UNIVERSITY

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

IISCA - Diego• Age: 11

• Diagnosis: Autism

• Language Level: Speaks in Short Sentences

• Referred for: Self-injurious behavior,Aggression, Property Destruction

LIFE SKILLS CLINICAT WESTERN NEW ENGLAND UNIVERSITY

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

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What does an informed analysis provide the practitioner?

1. a demonstration of problem behavior sensitivity to a suspected reinforcement contingency

2. a stable and sensitive baseline from which to evaluate treatment

3. a properly motivating set of conditions to teach important life skills

Analysis - Luke• Age: 4

• Diagnosis: Autism, Attention Deficit Hyperactivity Disorder

• Language Level: Fully fluent speech

• Referred for: Aggression, Property Destruction, Meltdowns

LIFE SKILLS CLINICAT WESTERN NEW ENGLAND UNIVERSITY

Sessions

1 3 5 7 9

Pro

ble

m b

ehav

ior

per

min

0

1

2

3

ControlTest

Luke

Escape to tangibles, attention,

mand compliance

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EXT Analysis –Luke

• Age: 4

• Diagnosis: Autism, Attention Deficit Hyperactivity Disorder

• Language Level: Fully fluent speech

• Referred for: Aggression, Property Destruction, Meltdowns

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EXT Analysis –Raj

• Age: 5

• Diagnosis: Autism

• Language Level: Single word utterances

• Referred for: Self-Injury, Aggression, Property Destruction

5 1 5 2 5

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c l a s s

I n c l u d e d i n

c o n t i n g e n c y

c l a s s

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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 just prior to our involvement

– Had school 1:1 (we served family)

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

IISCA: Interview-Informed Synthesized Contingency Analysis

1. Single

2. Individualized

3. Synthesized contingency

4. Reinforce precursors to and dangerous behavior

5. Test-matched

6. Rapid alternation of test and control conditions

Test

Control

Analysis

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Interview-informed&

Synthesized reinforcement contingencies

Most Important Aspects of our Approach

*Neither are novel*Neither are sufficiently recognized in current ABA research or practice

Why synthesize?

Isolated contingencies sometimes do not control behavior whereas synthesizedcontingencies do.

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

Syn

the

sized

Isola

ted

Isola

ted

From Hanley et al. 2014, JABA

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Ignore/Alone

EscapeTangible

Play

Attention

0

2

4 Escape totangiblesand attention

0

2

4 Escape totangiblesand attention

0

2

4Escape to rituals

2 4 6

0

1Escape to tangibles

5 10 15 20

Pro

ble

m b

ehav

ior

per

min

Sessions

IISCA Standard

Dylan

Emily

Chloe

Jeff

0

2

4

ControlTest

Escape totangibles

Analysis Comparison (Slaton et al., 2017, JABA)

Synthesized Isolated Sometimes both synthesized and isolated reinforcement contingencies influence problem behavior

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

Analysis Comparison (Slaton et al., 2017, JABA)

But our analyses show, more often, 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

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Synthesized Contingency First Author (Year) ParticipantsEscape to mand compliance Bowman (1997)

Eluri (2016)

Jessel (2016)

Roscoe (2015)

Ben, Jerry

Pablo

Allen, Mike, Jesse, Jian

Chris

Escape to previous activity Adelinis (1999)

Fisher (1998)

Hanley (2014)

Hagopian (2007)

Raffie

Ike, Tina

Bob

Perry, Maxwell, Kelly

Escape to rituals / stereotypy Leon (2013)

Rispoli (2014)

Jessel (2016)

Slaton (2017)

Laura

Timmy, John, Diego

Sam

Chloe

Attention + tangibles Brown (2000)

Ghaemmaghami (2016)

Hanley (2014)

Mann (2009)

Payne (2014)

Santiago (2016)

Jim

Jack, Nico

Gail

Madison

Samantha

Karen

Escape + tangibles Fisher (2016)

Jessel (2016)

Lambert (2017)

Lloyd (2015)

Roscoe (2015)

Slaton (2017)

Strohmeier (2016)

Cameron

Kristy, Jim, Carson, Chris, Mitch

S-2

Abhi, Sid

Jim

Riley, Dylan, Jeff,

S-1 (no pseudonym given)

Escape + attention Mueller (2005)

Payne (2014)

Sarno (2011)

Bob

Andrew

Brandon, Franklin, J’Marcus

Escape + attention

+ tangibles

Fisher (2016)

Ghaemmaghami (2015)

Jessel (2016)

Santiago (2016)

Slaton (2017)

Alan, Allie, Sylvia, Tina

Dan

Jeff, Gary, Wayne, Earl, Keo, Lee, Paul

Zeke

Diego, Emily, Kyle, Jonah

Escape + attention + tangibles +

mand compliance

Ghaemmaghami (2016)

Hanley (2014)

Jessel (2016)

Alex

Dale

Jian

Escape + preferred

conversation topics

Jessel (2016)

Santiago (2016)

Slaton (2017)

Sid, Beck, Steve

Karen

Mason

Isolated contingencies sometimes do not control behavior whereas synthesized contingencies do. From:

Nature and Scope of Synthesisin Functional Analysis and Treatment of Problem Behavior

Slaton & Hanley (in press, JABA)

Treatment efficacy often depends on synthesized contingenciesFrom:

Nature and Scope of Synthesisin Functional Analysis and Treatment of Problem Behavior

Slaton & Hanley (in press, JABA)

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 applications

Mea

n

bas

elin

e re

du

ctio

n

(%)

Synthesized contingencies had a better effect size in 25 of 26 cases (96%) and never had a smaller effect

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Treatment efficacy often depends on synthesized contingenciesFrom:

Nature and Scope of Synthesisin Functional Analysis and Treatment of Problem Behavior

Slaton & Hanley (in press, JABA)

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 applications

Mea

n

bas

elin

e re

du

ctio

n

(%)

>80% reductionin PB

12% 81%

Treatment efficacy often depends on synthesized contingenciesFrom:

Nature and Scope of Synthesisin Functional Analysis and Treatment of Problem Behavior

Slaton & Hanley (in press, JABA)

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 applications

Mea

n

bas

elin

e re

du

ctio

n

(%)

>80% reductionin PB

87%

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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 treatmentP

rob

lem

beh

avio

r p

er m

in

Sessions

Emily

Jeff

(Slaton et al., 2017, JABA)

and it works despite different participant characteristics and different implementation contexts

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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

blem

beh

avio

r pe

r m

in

Sessions

Pro

ble

m b

ehav

ior

per

min

ute

From Rajaraman et al. (2018)

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Strand & Eldevik (2017, Beh. Int.)

Herman, Healy, & Lydon (2018, Dev. Neuro.)

Jessel, Ingvarsson, Metras, Hillary, & Whipple (2018, JABA)

Beaulieu, Clausen, Williams, & Herscovitch (in press, BAP)

Chusid & Beaulieu (in press, JABA)

Similar effects reported in these—from other research groups

Effects deemed meaningful by parents and teachers following analysis and treatment involving synthesized reinforcement contingencies

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 et al. (2018) JABA

Achieving Socially Significant Reductions in Problem Behavior following the Interview-Informed Synthesized Contingency Analysis: A Summary of 25 Outpatient Applications

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Greater Motivational Distance Travelled

Why do qualitatively rich, ecologically relevant, and synthesized contingencies allow for effective outcomes?

Some candidate variables:

1. Greater amount of reinforcement

2. Varied reinforcers minimizing satiation

3. Provision of choice among reinforcers(which is reinforcing in and of itself)

4. Positive interactions between reinforcers (i.e., they may be complimentary reinforcers)

5. ….

For now, let’s simply consider this metaphor:

EO Sr

R

With SFA, there is relatively short motivational distance travelled as child transitions from:

no tangible to tangible , or

work to no work , or

no attention to attention (reprimands)

*that’s one interpretation

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EO Sr

R

EOEOEO

=

*here’s another interpretation

With SFA, there is sometimes a relatively short and incomplete motivational distance travelled during transition

E.g., Demand condition

no tangible, no attention,

no mand compliance, and work to no work

(& still no attention, tangibles,

or mand compliance)

EO Sr

R

EOEOEO

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

0

1

2

Escape topredictableschedule

Control

Test

EscapePlay

AttentionTangible

Alone

1 2 3 4 5

0

1

2Escape to tangibles,stereotypy, andattention

5 10 15 20 25

0

2

4

6

8

1 2 3 4 5

0

1

2

3Escape to tangiblesand attention

5 10 15

Pro

ble

m b

ehav

ior

per

min

Kyle

Jonah

IISCA Standard

Sessions

may lead to out of control

problem behavior in SFA may lead to a failure for an FCR to be acquired

An incomplete motivational distance travelled

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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:

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 wor

But, don’t forget about possible interactions:

which probably creates even greater motivational distance travelled

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EO Sr

R

EOEOEO Sr Sr Sr

0

1

2

Escape topredictableschedule

Control

Test

EscapePlay

AttentionTangible

Alone

1 2 3 4 5

0

1

2Escape to tangibles,stereotypy, andattention

5 10 15 20 25

0

2

4

6

8

1 2 3 4 5

0

1

2

3Escape to tangiblesand attention

5 10 15

Pro

ble

m b

ehav

ior

per

min

Kyle

Jonah

IISCA Standard

Sessions

With proper motivational distance travelled, problem behavior is evoked quickly in analyses and is discontinued once Sr is delivered

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

EO Sr

R

EOEO Sr Sr

With proper motivational distance travelled, FCRs are quickly acquired (& problem behavior does not usually persist during FCT)

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Skinner, 1958, S&HB, p. 205:

“A common source of misunderstanding is the neglect of what happens when variables are combined in different ways.

Although a functional analysis begins with relatively isolated relations, an important part of its task is to show how its variables interact.”

That which you must know from a functional analysis?

That which you can safely infer from a functional analysis?

That which you do not need to know from a functional analysis?

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That which I must know via my functional analysis:

That I can reliably turn problem behavior off with the presentation of the reinforcers

That I can reliably turn problem behavior on with the presentation of the evocative events

And that the reinforcers and evocative events were identified by other people relevant to the behaver

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

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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

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

That which I can safely infer via my functional analysis:

Response class membership

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Problem Behaviors reported to co-occur

(in order of concern)

1. SIB

2. Aggression

3. Disruptive Behavior

4. Disruptive vocalizations

5. Whining/complaining

This analysis shows all forms of problem behavior are evoked and maintained by same synthesized contingency.

This happens every time we conduct this sort of analysis.(Warner et al., 2016)

This happens every time anybody else conduct this sort of analysis (Smith and Churchill, 2002, Borrero & Borrero, 2008, Herscovitch et al., 2009)

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That which I can safely infer via my functional analysis:

Response class membership

Reported co-occurrence = maintained by same reinforcers

I will infer response class membership and use their response to intervention (RTI) as verification

That which I do not need to know via my functional analysis:

The single operant function of each problem behavior

Whether problem behavior is maintained by positive or negative reinforcement

Whether some element of a synthesized contingency is a “true” contingency or merely a “false positive”

Whether I can neatly compartmentalize the operation in the analysis into a tidy generic class of reinforcement

(e.g., social positive, social negative, attn, tang, esc, etc.)

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A final point…

High rates in tests sessions of functional analyses are not to be celebrated

Sessions

1 2 3 4 5 6Pro

ble

m B

ehav

ior

per

Min

0

2

4

6

8

10

ControlTest

Sylvie

Sessions

1 2 3 4 5

0.0

0.5

1.0

1.5

2.0

Escape toattention, tangibles

Reinforcement

Problem Behavior during Establishing Operation

Problem Behavior during Reinforcement

Seconds

0 50 100 150 200 250 300

0 30 60 90 120 150 180 210 240 270 300 330

Seconds

0 60 120 180 240 300 360

Session 2 Session 2

Session 4

Session 6

Session 4

Session 5

*

High rates of PB are not necessarily a good thing in a functional analysis

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Sessions

1 2 3 4 5 6Pro

ble

m B

ehav

ior

per

Min

0

2

4

6

8

10

ControlTest

Sylvie

Sessions

1 2 3 4 5

0.0

0.5

1.0

1.5

2.0

Escape toattention, tangibles

Reinforcement

Problem Behavior during Establishing Operation

Problem Behavior during Reinforcement

Seconds

0 50 100 150 200 250 300

0 30 60 90 120 150 180 210 240 270 300 330

Seconds

0 60 120 180 240 300 360

Session 2 Session 2

Session 4

Session 6

Session 4

Session 5

*

If you can control problem behavior in an analysis, you can treat

that behavior.

You can do this.

If you try but can’t control problem

behavior in an analysis, your treatment will likely create unsafe

situations, be ineffective, and

necessitate restrictive or socially invalid

treatment components.

Come up with at least one question relevant to conducting

this practical functional assessment process

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32

On to treatment at 1:15 today.

For more information, go to:

www.practicalfunctionalassessment.com