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Behavior Modification 2016, Vol. 40(5) 678 –712
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Article
A Systematic Review of Function-Based Replacement Behavior Interventions for Students With and At Risk for Emotional and Behavioral Disorders
John William McKenna1, Andrea Flower2, and Reesha Adamson3
Abstract Students with emotional and behavioral disorders and students considered at risk often have social deficits. Although social skills interventions are often provided to this student population, there are some concerns regarding how these interventions are conceived and provided. One possible way to improve the effectiveness of social skills interventions is to use functional behavior assessment data to tailor the interventions to a student’s individual needs and the contexts in which social skills deficits and problem behaviors occur. This approach is commonly referred to as replacement behavior training. In this study, the literature on function-based replacement behavior interventions is systematically reviewed. In addition, studies are evaluated according to the What Works Clearinghouse design and evidence standards for single- case research. Although this research base does not meet the What Works
1St. John’s University, Jamaica, NY, USA 2The University of Texas at Austin, USA 3Missouri State University, Springfield, USA
Corresponding Author: John William McKenna, St. John’s University, 8000 Utopia Parkway, Sullivan Hall 413, Jamaica, Queens 11439, NY, USA. Email: Mckennj1@stjohns.edu
621489 BMOXXX10.1177/0145445515621489Behavior ModificationMcKenna et al. research-article2015
McKenna et al. 679
Clearinghouse replication standards, function-based replacement behavior interventions appear to be a promising practice for addressing problem behaviors. Implications for practice, areas for future research, and study limitations are discussed.
Keywords social skills, replacement behavior interventions, function-based interventions, emotional and behavioral disorders
Students with challenging behavior such as those with emotional and behav- ioral disorders (EBD) commonly experience negative school outcomes such as progressive academic underperformance (Bullock & Gable, 2006; Wagner et al., 2006) and a lack of success in school (Lane, Carter, Common, & Jordan, 2012) even when provided special education services (Siperstein, Wiley, & Forness, 2011). Unfortunately, post-secondary outcomes are no bet- ter, evidenced by high rates of substance abuse and arrest within 3 to 5 years of leaving high school (Bullock & Gable, 2006; Wagner, Cameto, & Newman, 2003). These negative school and transition outcomes can be attributed in part to the pervasive problem behaviors that are characteristic of this student population (Vaughn, Levy, Coleman, & Bos, 2002)
Many students engage in problem behavior due to social skills deficits (Cook et al., 2008). In fact, poor social skills are characteristic of approxi- mately half of all students who receive special education services for Emotional Disturbance (ED; National Longitudinal Transition Study–2, 2006). Although researchers provide varying definitions of the social skills construct, Gresham (2015) noted that social skills included in intervention studies fall within social- cognitive, social interaction, and pro-social domains. Social skills can be con- ceived as a broad array of social behaviors that result in positive social outcomes (Gresham, Van, & Cook, 2006). For example, the successful use of social skills results in social competence (Gresham & Elliot, 2014), which is the perception by others that one performs pro-social behaviors, has positive relationships, and is socially accepted (Gresham, Elliot, & Kettler, 2010). Social skills are also considered academic enablers, which are behaviors that are required for one to engage in and profit from school instruction (Gresham, 2015).
Social Skills Instruction
Students with social skills deficits are often provided interventions (Dobbins, Higgins, Pierce, Tandy, & Tincani, 2010) to promote the use of socially appro- priate behaviors (Elksnin & Elksnin, 2006; Smith & Sugai, 2000) that result in
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peer and adult perceptions of social competence (Sugai & Lewis, 1996). Furthermore, interventions can prevent the occurrence of problem behavior (Gresham et al., 2006) by focusing on contextual factors associated with prob- lem behaviors that compete with social skill performance (Cook et al., 2008). In this conception of social skills intervention, competing behaviors are defined as problem behaviors that are more efficient at meeting a need than a function- ally equivalent social skill (Gresham et al., 2006). As the problem behavior results in outcomes that are desirable to the student, the student will continue to perform the problem behavior rather than socially competent and desired behaviors.
Issues With Typical Social Skills Instruction
Research has demonstrated the potential effectiveness of social skills inter- ventions for students with EBD. For example, Gresham, Cook, and Crew (2004) conducted a meta-analysis of social skills interventions provided to students with EBD and considered at risk. Interventions were considered moderately effective and resulted in practically significant changes. Although study findings were encouraging, Gresham and colleagues (2004) did not evaluate intervention outcomes regarding generalization and maintenance of behavior change. The researchers also note that interventions tended to not have strategies based on the type of social skill deficit (e.g., acquisition or performance).
Additional concerns regarding typical social skills interventions are found in the literature. For example, social skills interventions often fail to program for skill generalization, maintenance, and to consider the match between interventions and the specific nature of the skill deficit (Gresham, 1998, 2015; Maag, 2005). Instead, social skills interventions may rely on a standard protocol or curriculum (Gresham et al., 2004; Smith & Sugai, 2000) rather than being informed by an assessment of the contextual vari- ables that may prevent social skill performance (Maag, 2005). More recently, researchers have conceptualized social skills interventions as part of a multi- tiered system of behavioral support (Gresham, 2015; Gresham & Elliot, 2014). Although promising Tier 1 (i.e., universal) and Tier 2 (i.e., small group) approaches have been identified, researchers have pointed to the need to identify more intensive, Tier 3 social skills interventions for those students who inadequately respond to Tier 2 supports (Gresham, 2015). In fact, using assessment data to inform social skills interventions may be a promising approach for addressing this need for Tier 3 social skills interventions.
McKenna et al. 681
Functional Behavior Assessment (FBA) and Social Skills Training (SST)
FBA can be used to inform social skills interventions (Gresham, 2015). FBA employs indirect and direct data collection methods to (a) create a hypothesis that explains variables that predict the occurrence of competing problem behaviors and (b) develop a comprehensive function-based intervention (Ervin, Ehrhardt, & Poling, 2001). Function-based interventions are typically considered Tier 3 supports as they are individualized. FBA identifies anteced- ent and consequent conditions that maintain problem behavior, which can be incorporated into intervention development (Smith & Sugai, 2000). Furthermore, information derived from an FBA may inform the selection of social skills that are functionally equivalent to problem behaviors for instruc- tion (Gresham, 2015; Maag, 2005; Scott & Caron, 2005). This approach is referred to as replacement behavior training (RBT), in which functionally equivalent behaviors are taught and reinforced and contingencies are devel- oped to promote skill generalization and maintenance (Gresham, 2015; Gresham et al., 2006; Maag, 2005, 2006). RBT may also involve instruction in positive behaviors that are incompatible with problem behaviors (Gresham, 2015). Behaviors are considered incompatible when they cannot co-occur. With the use of differential reinforcement of incompatible behavior (DRI), replacement behaviors can be made functionally equivalent to problem behaviors.
For example, consider a student who continues to engage in challenging behavior despite receiving a typical Tier 2 small group social skills interven- tion. An FBA is completed to identify contextual factors that predict the prob- lem behavior and to identify replacement behaviors that can be targeted for instruction. It is determined that the student engages in challenging behaviors during independent seatwork to gain teacher attention. The student is then taught socially appropriate methods for recruiting teacher attention such as methods for requesting assistance. The social skill of asking for help is a replacement behavior because it is functionally equivalent to the challenging behavior that was effective at obtaining teacher attention. The FBA also informs recommendations for adjusting teacher behavior so that the student is more likely to perform the replacement behavior and less likely to perform the challenging behavior. For example, the teacher can provide attention when the student uses the instructed replacement behavior and ignore the student when the challenging behavior is used to obtain teacher attention. In fact, previous comprehensive syntheses of intervention research have inves- tigated the effectiveness of function-based interventions for students with EBD and students considered at risk.
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Previous Research on Function-Based Interventions
Lane, Umbreit, and Beebe-Frankenberger (1999) systematically reviewed nine years of research on the use of function-based interventions for this student popu- lation. This study represents an early effort to critically evaluate the extant litera- ture to guide school practice and future research. Lane and colleagues determined that the majority of interventions were antecedent-based and included young children as participants and few studies included maintenance measures. Lane and colleagues concluded that the research methodology included sufficient components for determining the validity of these interventions.
Lane, Kalberg, and Shepcaro (2009) conducted a comprehensive review of school-based function-based interventions for secondary students with EBD. In their analysis, the researchers evaluated the quality of the extant literature using quality indicators established by Horner et al. (2005). Lane and colleagues (2009) concluded that function-based interventions could not be considered an evidence-based practice for secondary students with EBD due to the presence of only one study that met the quality indicators. However, the researchers stated that the quality indicators may be too rigorous and that additional research is warranted. Although this study represents an important piece of scholarship on a student population in need of additional as well as rigorous research, it did not specifically focus on function-based replacement behavior interventions nor did it use a more recently developed set of quality indicators for single-case studies (Kratochwill et al., 2010).
More recently, Gage, Lewis, and Stichter (2012) conducted a meta-analy- sis of function-based interventions for students with or at risk for EBD. The researchers report that these interventions are effective at reducing problem behaviors for this student population. While Gage and colleagues (2012) applied a set of quality indicators (Horner et al., 2005) to the studies that met inclusion criteria, their study also did not focus exclusively on function-based replacement behavior interventions. At this time, there appears to be no pub- lished comprehensive synthesis of replacement behavior interventions for students with EBD and students considered at risk. Furthermore, the research- ers also did not use a more recently published set of recommendations for evaluating the quality of single-case research (Kratochwill et al., 2010).
What Works Clearinghouse (WWC) Pilot Standards
The WWC (Kratochwill et al., 2010) developed a multiple-gated procedure for evaluating the quality of single-case design studies and made recommen- dations for quantifying findings from studies that met specific criteria.
McKenna et al. 683
Table 1 summarizes this procedure, which is also reported in additional detail in the method section. Researchers have recently used these procedures to evaluate the extant literature on self-management interventions (Maggin, Briesch, & Chafouleas, 2013) and function-based interventions for students with learning disabilities (LDs; McKenna, Flower, Kim, Ciullo, & Haring, 2015). The synthesis presented here serves as an application of the WWC criteria to function-based replacement behavior interventions for students with EBD and considered at risk.
Purpose and Research Questions
The purpose of this synthesis is to expand upon previous syntheses of func- tion-based interventions (Gage et al., 2012; Lane et al., 1999) by investigat- ing replacement behavior interventions for students with EBD and students considered at risk. In addition, we sought to evaluate the quality of this research using the WWC criteria for single-case research to determine if this intervention is an evidence-based practice for this student population. As noted by Gresham (2015), there is a need to identify potentially promising Tier 3 social skills interventions. As function-based interventions are highly individualized and tend to be provided as a Tier 3 support, replacement behavior interventions may address this need. This synthesis is guided by the following research questions:
Research Question 1: What are the characteristics of function-based replacement behavior interventions for students with EBD and considered at risk? Research Question 2: What is the evidence-base for function-based replacement behavior interventions according to WWC quality indicators?
Method
A multi-step process was used to identify relevant studies. First, an electronic search of Academic Search Complete, PsycINFO, and ERIC databases was performed using combinations of the following search terms: behavior, func- tional behavioral assessment, FBA, functional assessment, structural analysis, functional analysis, intervention, replacement behavior, and social skills. Next, a hand search of the following journals was performed to identify any studies that were not found in the electronic search: Behavioral Disorders, Education and Treatment of Children, Exceptional Children, Journal of Applied Behavior Analysis, and Remedial and Special Education. In addition, online copies of abstracts from Journal of Emotional and Behavioral Disorders
684 Behavior Modification 40(5)
(continued)
Table 1. WWC Criteria for Design and Evidence Standards.
Design standard items
1. The independent variable must be systematically manipulated. 2. More than one assessor has measured each outcome variable repeatedly
over time. 3. The study reports inter-assessor agreement on at least 20% of the data
points in each condition (e.g., baseline, intervention). 4. The inter-assessor agreement must meet minimal thresholds such as .80 for
percentage agreement indices and .60 for kappa measures. 5. The study includes at least three attempts to demonstrate an intervention
effect at three different points in time or with three different phase repetitions.
6. For a phase to qualify as an attempt to demonstrate an effect, the phase must have a minimum of three data points.
Evidence standard items
Baseline analysis
• Do the data document a pattern of behavior in need of change? • Do the data demonstrate a predictable baseline pattern? • Is variability sufficiently consistent? • Is the trend either stable or moving away from the therapeutic direction?
Within phase analysis
• Does each phase, including baseline, have at least three data points? • Do the data within each phase non-baseline document a predictable data
pattern? • Is the variability sufficiently consistent? • Is the trend either sufficiently low or moving in the hypothesized direction?
Between phase basic effects
• Does between phase data document the presence of basic effects? • Are the level and trend discriminably different between the first and last
three data points in adjacent phases? • Is there an overall level change between baseline and treatment phases? • Is there an overall change in trend between baseline and treatment
phases? • Do the data patterns in similar phases (e.g., intervention-to-intervention)
demonstrate similar patterns? • Is there an overall change in variability between baseline and treatment
phases? • Is there sufficiently low overlap between baseline and treatment phases
to document an experimental effect?
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Table 1. (continued)
Evidence standard items
Between phase experimental effect
• Report the design. • How many opportunities were there to demonstrate a treatment effect? • How many treatment effects were demonstrated?
Overall effectiveness items
• Data points per phase. All phases considered must have a minimum number of data points. Studies with strong evidence must have at least five data points per phase; studies with moderate evidence must have 3 or 4 data points per phase; and studies with no evidence will have less than 3 data points per phase. How many data points are in each phase?
• Total demonstrations of treatment effect. There must be at least three demonstrations of a treatment effect. Based on visual analysis, were there at least three demonstrations of a treatment effect?
• Ratio of effects to non-effects. The presence of non-effects can compromise the strength of a study. The WWC criteria require at least three demonstrations of a treatment effect to provide evidence. If there are no instances of non-effect then the study demonstrates strong evidence; if these three demonstrations are accompanied by one instance of non-effect then the study demonstrates moderate evidence; if the ratio of effects to non-effects is greater than 3:1 (e.g., 2:1) then the study provides no evidence.
Overall evidence
• If a “0” was entered for any of the previous items, then the study demonstrates no evidence.
• If a “1” was entered for any of the previous items, then the study demonstrates moderate evidence.
• If all responses were “2” then the study demonstrates strong evidence.
Note. Design Standards 1 to 4 must be met to continue through the evaluation process. Answers to design Standards 5 and 6 indicate the degree to which a study meets standards: Meets, meets with reservations, or does not meet.
and Journal of Positive Behavior Interventions were searched due to a lack of access to printed copies of these journals. The title and abstract for each article were read and those that appeared to be a function-based intervention study were read in their entirety to determine if they met selection criteria. In total, 35 articles were read in their entirety to determine if they met article selection criteria. Finally, reference lists from reviews, syntheses, and meta-analyses of social skills and function-based intervention studies were checked for articles that met inclusion criteria. However, all articles present on reference lists were identified during the electronic or hand searches.
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Inclusion Criteria
Articles for this review were selected based on the following criteria:
• Articles were published in a peer-reviewed journal between 1980 and 2014;
• Participants were in Grades K-12; • Participants were receiving special education services for EBD, ED,
serious emotional disturbance (SED), attention-deficit/hyperactivity disorder (ADHD), a behavior disorder (BD), were considered at risk, or attended a school for students with EBD. Students with ADHD were included because it is a risk factor for EBD and this student pop- ulation has been included in previous reviews of interventions for stu- dents with EBD (Burke, Boon, Hatton, & Bowman-Perrott, 2015; Gage et al., 2012; Lane et al., 2009; Lane et al., 1999);
• Interventions were based on FBA, structural analysis, or functional analysis data;
• Interventions included RBT; • Interventions were delivered in a school setting in the United States.
The first and second author reviewed each study that was identified as a potential article to determine if it met selection criteria. Areas of disagree- ment were discussed until 100% agreement was obtained. Articles that were initially identified were commonly excluded for not including a replacement behavior intervention and for having participants who did not meet inclusion criteria. In total, 16 of the 35 articles met selection criteria for this study.
Article Coding
The first two authors independently read and coded each article using a cod- ing sheet that was piloted by the first and second authors. During piloting, the first and second authors independently coded one article that met inclusion criteria and then discussed the features necessary to answer the research questions as well as essential descriptive information. Once the coding sheet was finalized, all articles were coded for the following information: school and class characteristics (district information, public or private school, gen- eral education or special education classroom), participant characteristics (e.g., age, grade, disability status), FBA components used (e.g., direct and indirect methods) and who completed the FBA (e.g., researcher or school personnel), behavior function, intervention components (antecedent condi- tions modified, consequent conditions modified, instructed replacement
McKenna et al. 687
behaviors), interventionist characteristics, dependent variables, interobserver agreement data (IOA), fidelity data, major findings, and social validity data.
Coding for WWC criteria. The WWC criteria (Kratochwill et al., 2010) were applied to each study to determine whether function-based replacement behavior interventions are an evidence-based practice for students with EBD and students considered at risk. The first two authors, who have experience with single-case design, visual analysis, and the WWC criteria, used a coding sheet adapted from Maggin et al. (2013) to independently code each study. Studies were first coded for WWC design standards (e.g., dependent variable systematically manipulated, IOA data collected for at least 20% of observa- tions across phases) and classified as meeting design standards, meeting design standards with reservations, or not meeting design standards. For example, multiple baseline design studies that did not permit the demonstra- tion of an intervention effect at three different points in time would not meet design standards. Multiple baseline studies with at least six phases and five data points per phase could potentially meet design standards if other criteria were met. Multiple baseline studies with at least six phases and three data points per phase could potentially meet design standards with reservations if other criteria were met. For the purpose of this review, studies that stated they collected IOA data for at least 20% of all sessions were not considered as meeting minimum requirements for IOA data collection across study phases.
Those studies that met design standards with or without reservations were then coded according to WWC evidence standards (e.g., predictable baseline pattern, presence of at least three data points in each phase, degree of overlap between baseline and intervention phases). After coding according to evi- dence standards, each study was determined to have strong evidence, moder- ate evidence, or no evidence of a treatment effect. Only those studies that had strong or moderate evidence were considered in the next analysis phase.
Studies that met design and evidence criteria were compared with WWC replication standards to determine if function-based replacement behavior interventions were an evidence-based practice. According to WWC, an extant research base must meet the following replication criteria: Five separate stud- ies must include the same intervention (i.e., replacement behavior interven- tion that was informed by an FBA), the studies must be conducted by at least three research teams in three different geographic areas, and studies must include at least 20 participants. Due to the individualized nature of function- based interventions, the researchers expected variability in the overall func- tion-based replacement behavior intervention package. Challenging behaviors serve different functions, occur in various contexts, and can be addressed using numerous antecedent and consequent strategies in combination or in
688 Behavior Modification 40(5)
isolation. Furthermore, different replacement behaviors could be selected for instruction and taught using various instructional methods. For the purposes of this study, we investigated the extent to which replacement behavior inter- ventions that were informed by an FBA have been replicated, using the WWC design and evidence standards to identify this pool of studies.
Reliability
The first two researchers independently coded each article for descriptive information and compared coding sheets to determine areas of disagreement. Agreement was calculated for each study by dividing the total number of areas of agreement by the total number of study aspects that were coded. Initial mean agreement was 98.75%, ranging from 95% to 100%. When dis- agreements occurred, both researchers re-read the article and re-coded the study aspect for which the disagreement occurred. Areas of disagreement were then discussed until 100% agreement was obtained. A similar procedure was also followed for the WWC coding. For design and evidence standards, initial reliability was 98.5%, ranging from 96.7% to 100% and areas of dis- agreement were discussed until 100% agreement was achieved.
Results
In the following sections, we report findings related to our research ques- tions. First, a summary of the corpus of research and study characteristics is provided. Next we evaluate studies according to WWC design standards. Those studies that met design standards with or without reservations were then evaluated according to WWC evidence standards. Finally, we applied the WWC replication standards to those studies that had moderate to strong evidence of effectiveness.
Study Characteristics
Sixteen studies published between 1995 and 2014 met inclusion criteria. Studies were published in the following journals: Behavioral Disorders (n = 6), Education and Treatment of Children (n = 4), Journal of Positive Behavior Interventions (n = 2), Journal of Emotional and Behavioral Disorders (n = 2), Journal of Behavioral Education (n = 1), and Journal of Applied Behavior Analysis (n = 1). Table 2 reports descriptive information for each study.
Participant and setting characteristics. Studies included 28 participants, with 24 being male. Age was reported for 23 participants. Participant age ranged
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n A
ss es
sm en
t S ca
le (D
ur an
d &
C
rim m
in s,
19 88
); be
ha vi
or
ra tin
g sc
al e;
o bs
er va
tio n
Y Y
T ab
le 2
. ( co
nt in
ue d)
(c on
tin ue
d)
691
St ud
y Pa
rt ic
ip an
ts Se
tt in
g FB
A m
et ho
ds Fi
de lit
y So
ci al
v al
id ity
T ru
ss el
l, Le
w is
, a nd
St
ic ht
er (
20 08
) Fi
ft h-
gr ad
e M
w ith
ED
a nd
L D
in
or al
e xp
re ss
io n
an d
lis te
ni ng
co
m pr
eh en
si on
T hi
rd -g
ra de
M w
ith E
D Fi
rs t-
gr ad
e M
w ith
E D
A lte
rn at
iv e
pu bl
ic
sc ho
ol fo
r st
ud en
ts
w ith
m en
ta l h
ea lth
ne
ed s
an d/
or s
ev er
e ex
te rn
al iz
in g
be ha
vi or
s in
M id
w es
t sc
ho ol
di
st ri
ct
Ec ol
og ic
al a
ss es
sm en
t; te
ac he
r an
d st
ud en
t in
te rv
ie w
; o bs
er va
tio n;
F A
Y N
R
T ur
to n,
U m
br ei
t, an
d M
at hu
r (2
01 1)
12 th
-g ra
de C
M Pr
e- K
-1 2
al te
rn at
iv e
da y
sc ho
ol fo
r st
ud en
ts
w ith
E BD
a nd
m ild
t o
m od
er at
e di
sa bi
lit ie
s
R ec
or d
re vi
ew ; s
ta ff
an d
st ud
en t
in te
rv ie
w s;
ob
se rv
at io
ns
Y Y
U m
br ei
t (1
99 5)
T hi
rd -g
ra de
M w
ith
A D
H D
El em
en ta
ry s
ch oo
l; ge
ne ra
l e du
ca tio
n cl
as sr
oo m
T ea
ch er
a nd
s tu
de nt
in
te rv
ie w
s; C
BA ;
ob se
rv at
io n;
F A
N o
fo rm
al
da ta
Y
W hi
tf or
d, L
ia up
si n,
U
m br
ei t,
an d
Fe rr
o (2
01 3)
N in
th -g
ra de
C M
w ith
A
D H
D a
nd L
D H
ig h
sc ho
ol in
a ffl
ue nt
so
ut hw
es te
rn d
is tr
ic t;
ge ne
ra l e
du ca
tio n
cl as
sr oo
m s
St af
f, st
ud en
t, an
d pa
re nt
in
te rv
ie w
; o bs
er va
tio n
Y Y
W ri
gh t-
G al
lo ,
H ig
be e,
R ea
go n,
an
d D
av ey
( 20
06 )
14 .6
-y ea
r- ol
d M
w ith
EB
D 12
.9 -y
ea r-
ol d
M w
ith
EB D
Se lf-
co nt
ai ne
d cl
as sr
oo m
in
p ub
lic m
id dl
e sc
ho ol
T ea
ch er
a nd
p ar
en t
in te
rv ie
w ; F
A N
o fo
rm al
da
ta N
o fo
rm al
da
ta
N ot
e. F
BA =
F un
ct io
na l B
eh av
io r
A ss
es sm
en t;
M =
m al
e; S
ED =
s er
io us
e m
ot io
na l d
is tu
rb an
ce ; F
= fe
m al
e; N
R =
n ot
r ep
or te
d; E
D =
e m
ot io
na l
di st
ur ba
nc e;
A D
H D
= a
tt en
tio n-
de fic
it/ hy
pe ra
ct iv
ity d
is or
de r;
F A
= fu
nc tio
na l a
na ly
si s;
C =
C au
ca si
an ; O
H I =
o th
er h
ea lth
im pa
ir m
en t;
EB D
=
em ot
io na
l a nd
b eh
av io
ra l d
is or
de rs
; A A
= A
fr ic
an A
m er
ic an
; L D
= le
ar ni
ng d
is ab
ili ty
; C BA
= c
ur ri
cu lu
m b
as ed
a ss
es sm
en t;
Y =
y es
.
T ab
le 2
. ( co
nt in
ue d)
692 Behavior Modification 40(5)
from 7 to 17. Grade was reported for 23 participants, with the majority in the elementary grades. Ethnicity was reported for 10 participants: four African American and six Caucasian. One study (Lo & Cartledge, 2006) with two participants reported socioeconomic status, with both eligible for free or reduced lunch.
Disability status was reported for 27 participants. Six students were con- sidered at risk and 10 students were identified with SED, ED, or EBD. Three students were identified as students with ADHD, two with ED and ADHD, one with ED and an LD, one participant with ADHD and an LD, and one participant with EBD, ADHD, and language impairments.
Information on school setting was reported for all participants. Nineteen participants attended public schools and nine attended substantially separate schools. Nine participants attended a self-contained class within substantially separate schools. Ten participants were in self-contained classes within pub- lic schools. Seven participants attended general education classes. Two par- ticipants were in resource room and general education settings.
FBA methods. In 14 of 16 studies, researchers completed the FBA with some participation by school staff, primarily classroom teachers (Dunlap, White, Vera, Wilson, & Panacek, 1996; Dwyer, Rozewski, & Simonsen, 2012; Ellis & Magee, 1999; Filter & Horner, 2009; Hansen, Wills, Kamps, & Green- wood, 2014; Kamps, Wendland, & Culpepper, 2006; Lane, Weisenbach, Phil- lips, & Wehby, 2007; Lo & Cartledge, 2006; Smith and Sugai, 2000; Stahr, Cushing, Lane, & Fox, 2006; Turton, Umbreit, & Mathur, 2011; Umbreit, 1995; Whitford, Liaupsin, Umbreit, & Ferro, 2013; Wright-Gallo, Higbee, Reagon, & Davey, 2006). Researchers independently completed FBA proce- dures in one study (Meyer, 1999). In this study, researchers performed a func- tional analysis.
Teacher interview was the most commonly used FBA procedure (n = 27). Observation (n = 22), functional analysis (n = 16), and student interviews (n = 16) were also commonly used. Other FBA procedures used included record reviews (n = 9), parent interviews (n = 6), the Motivation Assessment Scale (n = 3; Durand, 1990), the Setting Factors Assessment Tool (n = 2; Stichter, Lewis, Johnson, & Trussell, 2004), and behavior rating scales (n = 2). Functional analyses occurred in analog settings, naturalistic settings (n = 8), and one in analog and naturalistic settings (n = 1).
Behavior function. Escape from tasks (n = 10) was the most common function of problem behavior. Additional functions included teacher attention (n = 7), escape from tasks and teacher attention (n = 4), peer and adult attention and
McKenna et al. 693
escape from tasks (n = 2), peer and teacher attention (n = 2), escape from tasks and peer attention (n = 2), and peer attention (n = 1).
Fidelity. Ten of the 16 studies that met inclusion criteria reported information on fidelity (Filter & Horner, 2009; Hansen et al., 2014; Lane et al., 2007; Lo & Cartledge, 2006; Stahr et al., 2006; Trussell et al., 2008; Turton et al., 2011; Umbreit, 1995; Whitford et al., 2013; Wright-Gallo et al., 2006). Seven studies (Hansen et al., 2014; Lane et al., 2007; Lo & Cartledge, 2006; Stahr et al., 2006; Trussell et al., 2008; Turton et al., 2011; Whitford et al., 2013) reported formal fidelity data, all of which were at acceptable levels. One study reported giving feedback to teachers but did not report formal data (Filter & Horner, 2009). One study reported no formal data though teachers stated that it was beneficial to have the researcher present (Wright-Gallo et al., 2006).
Social validity. Nine of 16 studies (Filter & Horner, 2009; Hansen et al., 2014; Lane et al., 2007; Lo & Cartledge, 2006; Stahr et al., 2006; Turton et al., 2011; Umbreit, 1995; Whitford et al., 2013; Wright-Gallo et al., 2006) reported information related to social validity. Five studies (Lane et al., 2007; Stahr et al., 2006; Turton et al., 2011; Umbreit, 1995; Whitford et al., 2013) used formal social validity measures. Three studies (Filter & Horner, 2009; Hansen et al., 2014; Lo & Cartledge, 2006) used researcher developed mea- sures or interview protocols. One study (Wright-Gallo et al., 2006) reported no formal data but provided information on teacher perceptions.
All nine studies that included social validity reported information on teacher perceptions. Overall, teachers perceived the interventions to be effec- tive and intervention procedures had a high degree of acceptability. However, self-management procedures were perceived as requiring greater effort to implement (Hansen et al., 2014) and self-monitoring was perceived to be inef- fective at changing student behavior (Stahr et al., 2006). Four studies (Filter & Horner, 2009; Lane et al., 2007; Stahr et al., 2006; Turton et al., 2011) reported information on student perceptions, which were positive in all studies.
Research Question 1: Intervention Characteristics
Skills selected for instruction tended to be a form of functional communica- tion training. For example, 15 interventions included procedures for teaching student participants to ask for help. Six interventions included procedures for teaching students how to ask for a break. Only one intervention focused on development of positive social interactions. Eight interventions included a self-monitoring component. Table 3 provides specific information on each function-based intervention.
694 Behavior Modification 40(5)
Table 3. Function-Based Interventions.
Study Antecedent conditions Consequent conditions Skill building
Dunlap, White, Vera, Wilson, and Panacek (1996)
Participant 1: Keywords highlighted; additional illustrations in text; shorter assignments; choice of assignments
None Raise hand to ask question or to inform teacher assignment completed
Participant 2: Enlarged print; increased space between letters, reduced number of items, worksheet choice
None Raise hand to ask for help or to inform teacher assignment completed
Dwyer, Rozewski, and Simonsen (2012)
Participant 1: None None Ask for help or break
Participant 2: None None Ask for help or break
Participant 3: None None Ask for help Ellis and Magee
(1999) None DRA, planned
ignoring, token economy, time out for dangerous behaviors
Ask for peer and adult attention
Study Antecedent conditions Consequent conditions
Replacement behaviors
Filter and Horner (2009)
None Planned ignoring; access to mastery level task for task completion
Ask for help
Hansen, Wills, Kamps, and Greenwood (2014)
Participant 1: Self- management checklist; teacher use of pre- correction
Break tickets for goal achievement; prompts when disruptive
Self-management
Participant 2: Self- management checklist; teacher use of pre- correction
Break tickets for goal achievement; prompts when disruptive
Self-management
Participant 3: Self- management checklist; teacher use of pre- correction
Break tickets for goal achievement; prompts when disruptive
Self-management
(continued)
McKenna et al. 695
Study Antecedent conditions Consequent conditions Skill building
Kamps, Wendland, and Culpepper (2006)
Self-recording of responses during choral work; teacher modeling during independent work
Increased praise, points, tickets for appropriate behaviors, limit use of reminders of class rules during group work; social reinforcement of task completion during independent work
Help cards for peer support, teacher support, and brief escape
Lane, Weisenbach, Phillips, and Wehby (2007)
Self-monitoring checklist, peer assistant, card with examples of positive statements
Teacher praise, adult attention for reaching goal, redirection and peers ignore negative interactions
Positive social interactions
Lo and Cartledge (2006)
Participant 1: Self- monitoring checklist
DRI, DRA Request teacher attention, self- monitoring
Participant 2: Self- monitoring checklist
DRI, DRA Request teacher attention, self- monitoring
Meyer (1999) Participant 1: None Reinforcement of help requests
Ask for help
Participant 2: None Reinforcement of help requests
Ask for help
Participant 3: None Reinforcement of help requests
Ask for help
Participant 4: None Reinforcement of help requests
Ask for help
Smith and Sugai (2000)
None Teacher praise for work completion, feedback when work not completed, computer time with peer for ignoring peers; computer time for self- recording
Self-monitor work completion, request adult attention, calming strategy, self- assessment of staying calm
Table 3. (continued)
(continued)
696 Behavior Modification 40(5)
Study Antecedent conditions Consequent conditions Skill building
Stahr, Cushing, Lane, and Fox (2006)
Self-monitoring checklist Teacher attention for on task, ignore off task and problem behavior, teacher response to yellow card in 5 min, teacher response to red card in 1 min, reinforce for every 5 instances of strategy use
Ask for teacher attention
Trussell, Lewis, and Stichter (2008)
Participant 1: Increased structure, reinforcement; pre- corrections, wait time, instructional talk for 40%-50% of class
Teacher attention for replacement behaviors
Raise hand to model skill, work with teacher, or work with peer
Participant 2: Increased structure, reinforcement; pre- corrections, wait time, instructional talk for 40%-50% of class
Teacher attention for replacement behaviors
Ask for extra time, ask for help
Participant 3: Increased structure, reinforcement; pre- corrections, wait time, instructional talk for 40%-50% of class
Teacher attention, opportunities to participate in class for use of target behaviors
Eyes on teacher during instruction, eyes on work during seatwork, wait turn while sitting with hand raised
Turton, Umbreit, and Mathur (2011)
Book opened to correct page
Teacher attention for 15 min on task, attention and break for replacement behavior, redirection and continued task demand for problem behavior
Raise hand, waiting, asking for help
Table 3. (continued)
(continued)
McKenna et al. 697
Study Antecedent conditions Consequent conditions Skill building
Umbreit (1995) Independent work away from other students, cooperative activities without his friends
Ignore disruptive behavior
Ask for break
Whitford, Liaupsin, Umbreit, and Ferro (2013)
Self-monitoring checklist, active supervision
Praise every 5 min for on task, peer attention at end of class, brief redirection than planned ignoring for problem behavior
Self-monitoring
Wright-Gallo, Higbee, Reagon, and Davey (2006)
Participant 1: None DRA Ask for break, help, and attention
Participant 2: None DRA Ask for break, help, and attention
Note. DRI = differential reinforcement of incompatible behavior; DRA = differential reinforcement of alternative behavior.
Table 3. (continued)
Nine of 16 studies included interventions that modified antecedent and consequent conditions (Hansen et al., 2014; Kamps et al., 2006; Lane et al., 2007; Lo & Cartledge, 2006; Stahr et al., 2006; Trussell et al., 2008; Turton et al., 2011; Umbreit, 1995; Whitford et al., 2013) and four studies included interventions that modified consequent conditions (Filter & Horner, 2009; Meyer, 1999; Smith & Sugai, 2000; Wright-Gallo et al., 2006). One study did not include any environmental modifications (Dwyer et al., 2012) and one study included modification of antecedent conditions only (Dunlap et al., 1996). Modifications to antecedent conditions often involved the presence of materials used during self-management plans. Modifications to consequent conditions often included contingencies for providing reinforcement for desired behaviors.
Research Question 2: Evidence-Base According to WWC Criteria
In this section, we evaluate the studies according to WWC criteria for single- case design studies. First, we applied the design standards to all studies
698 Behavior Modification 40(5)
identified during search procedures. Next, we applied the evidence standards to those studies that met design standards or met design standards with reser- vations. WWC replication standards for single-case studies were then applied to those studies with moderate or strong evidence of effectiveness.
Design standards. Table 4 reports coding according to design standards. Of the 16 studies that met inclusion criteria, nine studies (Ellis & Magee, 1999; Filter & Horner, 2009; Hansen et al., 2014; Kamps et al., 2006; Lane et al., 2007; Meyer, 1999; Trussell et al., 2008; Whitford et al., 2013; Wright-Gallo et al., 2006) with a total of 17 participants did not meet design standards. Four studies did not have three attempts to demonstrate an intervention effect and collection of IOA data for at least 20% of data points in each condition (Ellis & Magee, 1999; Filter & Horner, 2009; Hansen et al., 2014; Wright- Gallo et al., 2006). Two studies did not collect IOA data for at least 20% of data in each condition (Lane et al., 2007; Trussell et al., 2008). One study did not collect IOA data for at least 20% of data points in each condition and did not have a minimum of three data points in each phase so it could be consid- ered an attempt to demonstrate an effect (Kamps et al., 2006). In Meyer (1999), the researchers did not report collecting IOA data for at least 20% of data points for each condition and had fewer than the requisite 4 data points for each comparison in the alternating treatment design. Whitford et al. (2013) did not meet additional design standards specific to multiple probe designs related to the overlap of pre-intervention data points, the presence of data points immediately before the initiation of intervention phases, and the need to collect data on the dependent variable for baseline participants when another participant first moves into the intervention phase.
Two studies (Lo & Cartledge, 2006; Umbreit, 1995) with three partici- pants met design standards without reservations. Five studies (Dunlap et al., 1996; Dwyer et al., 2012; Smith & Sugai, 2000; Stahr et al., 2006; Turton et al., 2011) with eight participants met design standards with reservations. It should be noted that Stahr et al. (2006) included a multi-element design. The multiple baseline design within this study did not meet design standards but the withdrawal design met design standards with reservations.
Evidence standards. Evidence standards were applied to the seven studies that met design standards with or without reservations. Table 5 reports coding for the evidence standards. Three studies (Dwyer et al., 2012; Lo & Cartledge, 2006; Stahr et al., 2006) with five participants had no evidence of effective- ness. Two studies (Lo & Cartledge, 2006; Umbreit, 1995) with two partici- pants had strong evidence of effectiveness. Three studies (Dunlap et al., 1996; Smith & Sugai, 2000; Turton et al., 2011) with four participants
699
T ab
le 4
. W
W C
D es
ig n
St an
da rd
s C
od in
g.
St ud
y
IV
sy st
em at
ic al
ly
m an
ip ul
at ed
?
D V
m
ea su
re d
by m
or e
th an
o ne
as
se ss
or
ov er
t im
e?
IO A
c ol
le ct
ed
du rin
g at
le
as t 2
0% o
f da
ta p
oi nt
s fo
r ea
ch
co nd
iti on
?
IO A
m ee
ts
m in
im um
th
re sh
ol ds
?
Su ffi
ci en
t nu
m be
r of
p ha
se s
ba se
d on
de
si gn
?
Su ffi
ci en
t nu
m be
r of
d at
a po
in ts
p er
co
nd iti
on
or p
ha se
? Fi
na l r
at in
g
D un
la p,
W hi
te , V
er a,
W ils
on , a
nd
Pa na
ce k
(1 99
6) Y
es Y
es Y
es Y
es Y
es Y
es W
ith r
es er
va tio
ns
D w
ye r,
R oz
ew sk
i, an
d Si
m on
se n
(2 01
2) Y
es Y
es Y
es Y
es Y
es Y
es W
ith r
es er
va tio
ns
El lis
a nd
M ag
ee (
19 99
) Y
es Y
es N
o Y
es N
o Y
es D
oe s
no t
m ee
t st
an da
rd s
Fi lte
r an
d H
or ne
r (2
00 9)
Y es
Y es
N o
Y es
N o
Y es
D oe
s no
t m
ee t
st an
da rd
s H
an se
n, W
ill s,
K am
ps , a
nd
G re
en w
oo d
(2 01
4) Y
es Y
es N
o Y
es N
o Y
es D
oe s
no t
m ee
t st
an da
rd s
K am
ps , W
en dl
an d,
a nd
C ul
pe pp
er
(2 00
6) Y
es Y
es N
o Y
es Y
es N
o D
oe s
no t
m ee
t st
an da
rd s
La ne
, W ei
se nb
ac h,
P hi
lli ps
, a nd
W
eh by
( 20
07 )
Y es
Y es
N o
Y es
Y es
Y es
D oe
s no
t m
ee t
st an
da rd
s Lo
a nd
C ar
tle dg
e (2
00 6)
Y es
Y es
Y es
Y es
Y es
Y es
W ith
ou t
re se
rv at
io ns
(c on
tin ue
d)
700
St ud
y
IV
sy st
em at
ic al
ly
m an
ip ul
at ed
?
D V
m
ea su
re d
by m
or e
th an
o ne
as
se ss
or
ov er
t im
e?
IO A
c ol
le ct
ed
du rin
g at
le
as t 2
0% o
f da
ta p
oi nt
s fo
r ea
ch
co nd
iti on
?
IO A
m ee
ts
m in
im um
th
re sh
ol ds
?
Su ffi
ci en
t nu
m be
r of
p ha
se s
ba se
d on
de
si gn
?
Su ffi
ci en
t nu
m be
r of
d at
a po
in ts
p er
co
nd iti
on
or p
ha se
? Fi
na l r
at in
g
M ey
er (
19 99
) Y
es Y
es N
o Y
es Y
es N
o D
oe s
no t
m ee
t st
an da
rd s
Sm ith
a nd
S ug
ai (
20 00
) Y
es Y
es Y
es Y
es Y
es Y
es W
ith r
es er
va tio
ns St
ah r,
C us
hi ng
, L an
e, a
nd F
ox
(2 00
6) Y
es Y
es Y
es Y
es Y
es Y
es W
ith r
es er
va tio
ns
T ru
ss el
l, Le
w is
, a nd
S tic
ht er
( 20
08 )
Y es
Y es
N o
Y es
Y es
Y es
D oe
s no
t m
ee t
st an
da rd
s T
ur to
n, U
m br
ei t,
an d
M at
hu r
(2 01
1) Y
es Y
es Y
es Y
es Y
es Y
es W
ith r
es er
va tio
ns
U m
br ei
t (1
99 5)
Y es
Y es
Y es
Y es
Y es
Y es
W ith
ou t
re se
rv at
io ns
W hi
tf or
d, L
ia up
si n,
U m
br ei
t, an
d Fe
rr o
(2 01
3) Y
es Y
es Y
es Y
es Y
es N
o D
oe s
no t
m ee
t st
an da
rd s
W ri
gh t-
G al
lo , H
ig be
e, R
ea go
n, a
nd
D av
ey (
20 06
) Y
es Y
es N
o Y
es N
o Y
es D
oe s
no t
m ee
t st
an da
rd s
N ot
e. IV
= in
de pe
nd en
t va
ri ab
le ; D
V =
d ep
en de
nt v
ar ia
bl e;
IO A
= in
te ro
bs er
ve r
ag re
em en
t.
T ab
le 4
. ( co
nt in
ue d)
701
T ab
le 5
. W
W C
E vi
de nc
e St
an da
rd s
C od
in g.
St ud
y Ba
se lin
e an
al ys
is
W ith
in
ph as
e an
al ys
is
Be tw
ee n
ph as
e ba
si c
ef fe
ct s
Be tw
ee n
ph as
e ex
pe ri
m en
ta l e
ffe ct
O ve
ra ll
ef fe
ct iv
en es
s O
ve ra
ll ev
id en
ce
D un
la p,
W hi
te , V
er a,
W
ils on
, a nd
P an
ac ek
(1
99 6)
Y es
Y es
Y es
Y es
; t hr
ee t
re at
m en
t ef
fe ct
s de
m on
st ra
te d
Y es
M od
er at
e ev
id en
ce
D w
ye r,
R oz
ew sk
i, an
d Si
m on
se n
(2 01
2) Y
es fo
r 2
pa rt
ic ip
an ts
Y es
fo r
on e
pa rt
ic ip
an t
Y es
fo r
1 pa
rt ic
ip an
t N
o; o
ne t
re at
m en
t ef
fe ct
de
m on
st ra
te d
N o
N o
ev id
en ce
Lo a
nd C
ar tle
dg e
(2 00
6) Y
es Y
es fo
r on
e pa
rt ic
ip an
t Y
es fo
r 1
pa rt
ic ip
an t
Y es
fo r
on e
pa rt
ic ip
an t;
th re
e tr
ea tm
en t
ef fe
ct s
de m
on st
ra te
d
Y es
fo r
on e
pa rt
ic ip
an t
St ro
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702 Behavior Modification 40(5)
demonstrated moderate evidence of effectiveness. It should be noted that there was no evidence of effectiveness for two dependent variables (talk- outs, off task) in Smith and Sugai (2000). It also should be noted that Lo and Cartledge (2006) had one intervention with no evidence of effectiveness and one intervention with moderate evidence.
Replication standards. Finally, the replication standard was applied to those studies that provided moderate or strong evidence of effectiveness. Accord- ing to this standard, replication with at least 20 participants from at least five single-case studies conducted by at least three research teams with no over- lapping authors is considered adequate replication (Kratochwill et al., 2010). While five studies demonstrated moderate or strong evidence of effective- ness, two of these studies had the same author. Furthermore, studies with strong or moderate evidence of effectiveness only included six participants. As a result, function-based replacement behavior interventions cannot be considered an evidence-based practice for students with EBD and considered at risk when this body of research is evaluated according to the WWC stan- dards for single-case design.
Discussion
Negative school and post-secondary outcomes are common experiences for students with and at risk for EBD (Wagner, Newman, & Cameto, 2004; Zhang, Katsiyannis, & Herbst, 2004). Deficits are characteristic of this stu- dent population and contribute to social rejection, withdrawal, and isolation (Mathur, Kavale, Quinn, Forness, & Rutherford, 1999) and may also play a role in school failure and dropout (Maag, 2006). Although social skills inter- ventions are commonly provided to this student population, they are often ineffective when evaluated in terms of skill generalization and maintenance (Gresham, 1998; Maag, 2006). Social skills interventions that are informed by FBA data and use a replacement behavior approach may be a promising method for improving the effectiveness of these interventions (Gresham, 2015). The purpose of this synthesis was to review the literature on function- based replacement behavior interventions for students with EBD and those at risk to determine the characteristics of the interventions. Due to the individu- alized nature of function-based interventions, the studies reviewed here relied on single-case design; therefore we also used the WWC standards for single- case design to determine if these interventions could be considered an evi- dence-based practice for this student population or potentially promising Tier 3 intervention.
McKenna et al. 703
Students with and at risk for EBD demonstrate significant social skills deficits (Gresham et al., 2004). Furthermore, the reasons for or function of challenging behaviors is not always readily apparent. A combination of FBA- driven social skills or replacement behavior instruction seems well-warranted for this population. Despite the apparent need for interventions informed by assessment data, a major finding of this study was the lack of studies address- ing this need. Considering the broad array of behaviors that are considered social skills (Gresham et al., 2006) as well as the potential utility of a func- tion-based replacement behavior approach to intervention, this finding is sur- prising. Beyond the dearth of studies in general, research has not yet addressed the use of FBA with replacement behavior instruction across the heteroge- neous population of students with or at risk for EBD. These concerns are outlined in the following sections.
Student and Study Characteristics
Few studies involved female participants, occurred in high school settings, and addressed internalizing behavior problems. This is consistent with previ- ous research, which found that most studies of function-based interventions with students with EBD or at risk occurred in elementary school settings and predominately had male participants (Gage et al., 2012; Lane et al., 2009). The lack of studies involving students with internalizing behaviors is also not surprising. A previous review (Kern, Hilt, & Gresham, 2004) of functional assessment with students with EBD or at risk found only one study that had participants with internalizing problem behaviors. Students with behaviors that are consistent with internalizing disorders may not be selected for inter- vention as these types of behaviors are often not as concerning to educators as externalizing behaviors (Walker, Ramsey, & Gresham, 2004), which can disrupt the class environment. The lack of studies with internalizing behav- iors may also play a role in the limited number of female participants, who may be more likely to have internalizing disorders (Kramer, Krueger, & Hicks, 2008).
FBAs
Researchers conducted FBAs with some involvement from school personnel, a tendency that is consistent with the FBA literature. For example, a review by Solnick and Ardoin (2010) noted that classroom teachers were rarely involved in data collection during the assessment process. Developing school capability to implement FBA with fidelity has been of concern (see Scott & Kamps, 2007). Studies in this review also point to a need to develop the
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capability of schools to implement FBA and function-based interventions with minimal support from researchers.
Fidelity
The inclusion of fidelity data in more recent studies is an encouraging find- ing. Direct measurement of fidelity is necessary so that change in student behavior can be attributed to the intervention (Gresham, MacMillan, Beebe- Frankenberger, & Bocian, 2000). Although assessment of fidelity is a neces- sary component of special education research, it is often not reported in intervention studies (Swanson, Wanzek, Haring, Ciullo, & McCulley, 2013). The inclusion of fidelity data in more recent studies may be indicative of a shift toward more frequent assessment of fidelity.
Social Validity
Teachers and student participants rated function-based interventions highly. However, it should again be noted that these interventions were implemented with researcher support. As a result, the extent to which these interventions are socially valid when implemented with typical resources is unknown. However, social validity findings of this review are encouraging.
Research Question 1
Interventions included in this review tended to involve multiple changes to “business as usual.” While it appears that classroom teachers were able to make these changes with a degree of consistency as indicated by the available fidelity data, they were done so under the guidance of researchers. However, in a typical school-based situation, teachers do not have researchers or uni- versity faculty who are experts in function-based interventions as a potential resource. As a result, teachers implementing function-based replacement behavior interventions may benefit from ongoing coaching and monitoring of intervention fidelity by special educators, school psychologists, or some other school-based professional who is also fluent in function-based inter- ventions and procedures.
Replacement behaviors targeted for instruction were predominately func- tional communication skills that could be used by students during academic instruction. This may be due a focus on behaviors that interfered with aca- demic instruction rather than behaviors that interfered with peer interactions during less structured school times such as recess and lunch or behaviors that interrupted pair or small group work. Replacement behaviors related to peer
McKenna et al. 705
and social interactions or to skills necessary for group collaborative work were absent from studies that met inclusion criteria. As a result, the efficacy of function-based replacement behavior interventions to develop these skills is unknown. Considering the potential effectiveness of peer mediated instruc- tion to develop academic skills (McKenna, Shin, & Ciullo, 2015; Wexler, Reed, Pyle, Mitchell, & Barton, 2013), limited proficiency in the prerequisite skills for active participation in group work could adversely affect the out- comes of this type of instruction for this student population.
Research Question 2
As previously stated, function-based replacement behavior interventions for students with EBD and students considered at risk cannot be considered an evidence-based practice according to the WWC single-case standards. However, use of function-based interventions does appear to be a promising school practice for decreasing problem behaviors. Less clear is the degree to which these interventions resulted in student performance of instructed replace- ment behaviors as few studies directly measured student use of these skills. Unfortunately, this means that conclusions regarding the effectiveness of these interventions at increasing positive behaviors are more tentative. When design- ing interventions to meet the needs of students with challenging behaviors, it is important to consider strategies that will decrease problem behaviors and increase appropriate behaviors (Conroy, Dunlap, Clarke, & Alter, 2005).
Although not part of the process for evaluating studies according to the WWC standards, the lack of generalization and maintenance measures in the studies that met inclusion criteria is worthy of consideration. Gresham called attention to researchers’ and practitioners’ failure to program for generaliza- tion in 1998. However, there is little evidence that this tendency has changed. In fact, of the seven studies that had a dependent variable that met WWC design standards with or without reservations, only two (Lo & Cartledge, 2006; Turton et al., 2011) measured generalization effects. However, it is encouraging that these two studies were more recent. Other researchers aim- ing to study function-based replacement behavior interventions may use these studies as models for their own future work. Although breaking a pat- tern of negative behavior provides an opportunity to access instruction and to develop more positive social relationships, behavior change must endure and occur in multiple contexts. Taking this into consideration, function-based replacement behavior interventions may best be considered a strategy that may be most effective when it can be implemented across settings.
In regard to maintenance of behavior change, only three studies that met WWC design and evidence standards (Lo & Cartledge, 2006; Turton et al.,
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2011; Umbreit, 1995) measured this effect. This is consistent with a previous review (Lane et al., 1999) of function-based interventions that also found few studies that reported maintenance. In regard to the current review, mainte- nance effects were encouraging in all three studies. Again, researchers inter- ested in investigating the maintenance effects of function-based replacement behavior interventions could potentially use these studies to inform their own research efforts.
Interventions included in this review were complex and involved multiple components. Due to the absence of component analysis, the value added by each component cannot be determined. The lack of component analysis may have been driven by a desire provide the full intervention to students in a timely manner and possibly a belief that the full intervention was necessary to address intractable problem behaviors. Although fidelity data could be used to determine which aspects of the interventions were most salient, the manner in which fidelity data were reported (i.e., few studies reporting fidel- ity data, no studies analyzing effectiveness in terms of fidelity) prevented this type of analysis.
Limitations
As typical with syntheses of the literature, a few limitations are present. First, we only reviewed published literature. It is likely there are a number of unpublished articles including dissertations on the topic with further promis- ing findings, but because they are unpublished they did not meet our inclu- sion criteria. Generalization of the findings is also limited due to the diverse set of participants with regard to age, grade, school setting in which they received educational services, and disability status. As a result, it is difficult to make conclusions regarding intervention effectiveness for specific student populations. As most studies involved students with externalizing behavior problems, it is also difficult to make generalizations regarding the effective- ness of function-based SST and RBT for students with internalizing behav- iors. Although function-based replacement behaviors appear to be a promising practice for decreasing problem behaviors, less is known regarding their effect on positive behaviors such as those skills that were specifically tar- geted for instruction. Finally, few conclusions can be drawn regarding main- tenance and generalization of behavior change.
Future Research
Future research should focus on replicating function-based skills interven- tions as well as include female participants and students with internalizing
McKenna et al. 707
problem behaviors. Furthermore, researchers should address a broader range of needs and outcomes such as how FBA and replacement behavior interven- tions may promote academic achievement along with behavioral improve- ment. Future studies should also investigate methods for promoting skill maintenance and generalization with careful attention paid to treatment integrity and making the process of student identification, assessment, inter- vention development, and intervention implementation transparent. Future research should also measure student use of instructed replacement behaviors and focus on developing positive peer interactions. Most importantly, future research should investigate the resources and building-level expertise neces- sary for schools to implement function-based replacement behavior interven- tions with fidelity and to deliver these supports in a timely and efficient manner.
Implications for Practice
This review highlights a number of implications for school practice. Schools should consider the use of function-based replacement behavior interventions for students who inadequately respond to typical social skills interventions. For example, students who continue to engage in problem behaviors despite the provision of Tier 2 intervention may benefit from an individualized inter- vention that is informed by FBA data. Although school practitioners may expect student gains from these interventions, evidence of behavior mainte- nance and generalization are minimal for the former and non-existent for the latter. In the event that skill generalization and maintenance fail to occur, practitioners may need to reassess the contextual variables that predict prob- lem behavior and identify new functionally equivalent replacement behaviors to promote skill maintenance and generalization. However, schools may not possess the expertise and resources to effectively implement this type of intervention. As a result, researchers and practitioners should work in concert to identify practices that can be delivered effectively in school settings under typical conditions.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publi- cation of this article.
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Author Biographies
John William McKenna, PhD, is an assistant professor of special education at St. John’s University, New York. His primary research interests are evidence-based instructional practices for students with emotional and behavioral disorders and stu- dents considered at risk and responsible inclusion. He is also interested in teacher preparation and positive behavior supports.
Andrea Flower, PhD, is an assistant professor of special education at The University of Texas at Austin. Her primary research interests focus on use of positive behavior strategies to facilitate academic and behavioral change. She is also interested in teacher preparation for managing challenging behavior in school settings.
Reesha Adamson, PhD, is an assistant professor in the Department of Counseling Leadership and Special Education at Missouri State University, Springfield. Her pri- mary research interests are positive behavior supports, observation research, and evi- dence-based practices for students with emotional and behavioral disorders.