9-1 intervention

Functional Behavioral Assessment, Diagnosis, and Treatment

Ennio Cipani, PhD, is a licensed psychologist in California since 1983. He has been doing in-home and in-school behavioral consultation for children with problem behaviors for four decades. Dr. Cipani has published numerous articles, chapters, books, and software in the areas of child behavior management and parent and teacher behavioral consultation. He coauthored Behavioral Classification System for Problem Behaviors in Schools: A Diagnostic Manual (Springer Publishing, 2017).

Functional Behavioral Assessment, Diagnosis, and Treatment A Complete System for Education and Mental Health Settings Third Edition

Ennio Cipani, PhD

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Library of Congress Cataloging-in-Publication Data Names: Cipani, Ennio, author. Title: Functional behavioral assessment, diagnosis, and treatment : a  complete system for education and mental health settings / Ennio Cipani. Description: Third edition. | New York, NY : Springer Publishing Company,  LLC, [2018] | Includes bibliographical references and index. Identifiers: LCCN 2017013589 | ISBN 9780826170323 | ISBN 9780826170330 (e-book) Subjects: I MESH: Behavior Therapy—methods | Personality Assessment | Mental  Disorders—diagnosis | Mental Disorders—therapy | Clinical Protocols Classification: LCC LB1060.2 | NLM WM 425 | DDC 370.15/28—dc23 LC record available at https://lccn.loc.gov/2017013589

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Directions for Acquiring Online Instructor’s Material vii Preface ix Acknowledgments xvii

1. Basic Concepts and Principles 1

2. Functional Behavioral Assessment of Problem Behavior 35

3. The Cipani Behavioral Classification System 91

4. Function-Derived Treatment Options 139

5. Functional Behavioral Treatment Protocols for SMA 2.0: Target Behaviors 185

6. Functional Behavioral Treatment Protocols for SME 4.0: Problem Behaviors 255

Appendix A: Cipani EO School Behavioral Interview Form 311 Appendix B: Why Artie Can’t Learn 315 Index 321

Contents

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Directions for Acquiring Online Instructor’s Material

This online instructor’s manual is available for qualified faculty who use this book as an adopted text for their course. Instructors can send an e-mail to textbook@springerpub .com to request access to these useful materials.

The online instructor’s manual includes the following:

ll A pool of chapter test items (multiple-choice and true/false items) that are separated into areas of content within each chapter (e.g., items measuring student’s comprehension of analogue assessment methods)

ll Measurement items (short answer) for determining student competency with each chapter objective

ll A narrated PowerPoint presentation detailing the supplemental materials and suggestions for use

ll “Modularized” chapter PowerPoint slide presentations with group assignments (called active student responses or ASRs) within each module section

ll Course Syllabus Builder: provides word files that can be copied and pasted to develop many of the components required in a course syllabus, such as: l° Brief descriptions of each chapter l° Chapter topics l° Chapter objectives and BACB task lists for each chapter l° Discussion questions l° A gradebook l° Assignment details and rubrics for scoring (including signature assignment

mentioned in Preface ll “What to Read if You Used the Second Edition,” a conversion guide that identifies the

differences between the second and third editions.

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Purpose of This Book This book provides a comprehensive approach to designing behavioral treatments for children in homes and residential facilities, students in special and general education settings, and adults residing in inpatient units and facilities. Providing effective behavioral treatment strategies in these settings requires an understanding of the problem behavior’s environmental function. A comprehensive approach to a behavior-analytic model involves the following: (a) conducting a functional behavioral assessment (FBA), (b) selecting a function-based hypothesis or classification of the problem, and (c) designing a function- based behavioral intervention or treatment. In regard to the hypothesis or classification activity, the forthcoming content of this text features the Cipani Behavioral Classification System (BCS). The Cipani BCS is a pioneering and groundbreaking taxonomy for classifying the functions of problem behaviors (Cipani & Cipani, 2017; Cipani & Schock, 2007, 2011). Codification of problem behaviors on the basis of the form of behavior or clusters of behaviors is the prevalent model in education and human services. But such a taxonomy is both insufficient and immaterial for a functional behavioral treatment approach. To provide treatment related to the problem behavior’s contextual factors, a classification system must provide a framework for classifying behavioral phenomena that represent the same or similar environmental context factors. The Cipani BCS does so! Additionally, the same pragmatic model needs to be existent for behaviors that should be strengthened in the individual client or student’s repertoire. This text also provides a revolutionary classification system for determining the strength of replacement behaviors and functions: The Cipani Diagnostic Classification System for Replacement Functions.

How is a functional approach different from merely prescribing treatment based on the form of behavior? Let us say we have identified the following target behaviors for a student in a special education class for behavior disorders: aggressive behavior, noncompliance, and tantrum behaviors. Suppose behavioral assessment data reveal that all these behaviors occur when the student is asked to read a passage aloud. The child may initially refuse to read when called upon. The child’s refusal to read is unsuccessful, as the teacher moves closer to the child to “coax” him or her, the child then throws a tantrum. As the child finds the tantrum doesn’t work, he or she does find that the teacher becomes more coercive. Finally, the student gets out of his or her seat and issues profanities about the assignment. By understanding that all these behaviors have the same environmental function, a functional treatment can address them as a response class. Further, one may be able to determine why such a task generates escape behavior with this child.

In the 21st century, selecting effective treatment for specific individual problem behaviors requires a greater understanding of the environmental function of problem behavior. This book addresses that need for a variety of potential users of behavioral technology. At the

Preface

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heart of this approach there are three sequential phases: (a) an FBA, (b) a function-based diagnostic classification of problem behavior, that is, Cipani BCS, and (c) a designation of a functional behavior-analytic treatment with consideration and analysis of the strength of the designated replacement function.

We take the position that a complete understanding of a behavioral function is necessary to conduct FBAs, diagnose the putative function via a classification system, and prescribe a function-based treatment. It is not simply enough for a text to offer boilerplate forms for use. One must ensure that an underpinning theoretical framework is offered and understood by the user as a prerequisite for utilizing provided fill-in-the-blank forms. It is to this end that this text provides a comprehensive discussion of basic concepts of the environmental function of behavior, prior to the chapters that detail assessment and treatment procedures.

This functional approach is suited for cases in which the problem behaviors are primarily operant in nature. The rate of operant behaviors is determined by their consequences. In some cases, referred problems may be respondent in nature (e.g., crying due to extreme physical pain; see Bailey & Pyles, 1989, for greater delineation of these factors). In these cases, this classification system is not applicable because the behavior may not be a function of any desired consequence (on the part of the client). Under these circumstances, it might be advisable to consult with a professional who may have experience with such problems.

Audience Textbook Market This book can serve as a primary text for university graduate training programs in applied behavior analysis (ABA). Such programs may have a sequence of courses approved as meeting the Board Certified Behavior Analyst (BCBA) task list requirement by the Behavior Analysis Certification Board (BACB). This text is of great utility in such ABA programs as it can be used in several different courses. Several chapters address assessment concerns that would fit into courses involving behavioral functional assessment. Several of the later chapters in the text that focus on functional treatment would be appropriate for courses covering application and intervention. The task lists objectives that are addressed by each chapter are delineated in the front part of the Chapters 1 through 4.

This third edition has undergone changes and revisions that would make it more user-friendly for preservice programs that are not necessarily BCBA-approved track programs. Graduate programs in school psychology and special education can also use this material as an  adopted text requirement for several courses. Again, because of the nature of this text covering both assessment and intervention, it can be used in multiple courses in school psychology: behavioral assessment, emotional behavioral assessment, and school consultation. Special education programs also share courses that deal with school consultation, as well as courses covering behavior management and methods courses that deal with behavioral intervention. Both sets of courses would find this text appropriate as a required text for their course objectives. Chapter 3 of this current text could be supplemented with several classes covering the diagnostic manual material of the Cipani BCS (Cipani & Cipani, 2017).

Practitioner Market This book is also intended for applied personnel who design behavioral programs for persons with challenging behaviors in a variety of settings, such as individual homes or group residences; public or private facilities; schools; hospital, community, or clinic settings; and inpatient settings. This book should be helpful to people who are trained in ABA and are looking for an additional resource to guide them in their assessment and treatmen-design activities. It is written also to serve personnel who have some familiarity with behavioral programs but have not discerned how to provide a functional behavioral treatment for specific functions of target problem behavior. The following clinical and educational practice

Preface xi

areas are particularly pertinent for personnel with some familiarity regarding FBA and positive behavioral intervention.

School Personnel Working With Special Needs Student. The use of behavioral technology, involving assessment and treatment activities, has proliferated in school settings in the last several decades. The explosion in utilization was the result of the 1997 Federal Individuals With Disabilities Education Act statute and promulgated regulations. This law required FBAs and positive behavioral interventions for students with challenging behaviors who are served in some capacity in special education via an Individual Education Plan. As a result, school psychologists and others are tasked with conducting an FBA if certain behavioral criteria are met for a given student. Teachers are subsequently tasked with data collection efforts during the assessment phase. They also have a primary responsibility in implementing any prescribed behavioral intervention to address the challenging behaviors in the student’s school settings.

Personnel Who Work in Inpatient Units and Residential Facilities. The use of behavior-analytic treatments is finding its way into inpatient units, residential facilities, and community settings for persons with severe mental illness, developmental disabilities, and sustained brain injury. Although there is no federal or state imperative requiring an FBA or functional behavioral intervention plan in these settings, simply designing arbitrary contingency interventions can lead to ineffective treatment or worse, disastrous treatment. Mental health providers in these settings who determine what the function of presenting problem behaviors serve will be more capable in ameliorating behavior problems. The client’s possible reintegration into mainstream settings will hinge on such progress.

Personnel Who Provide Parent Training/Consultation. Parent training and consultation, from a behavioral framework, has been verified as an efficacious treatment for child problems in home settings. Psychologists, psychiatrists, nurses, and other mental health providers should be providing technical behavioral assistance to parents who need specific help for problem behaviors. This book provides such professionals with a resource for designing individualized functional behavioral treatment programs.

Overview of Material This book is now divided into six chapters, which is a change from the prior two editions. Due to the increasing length of material covered in Chapter 5 in previous editions, the material has now been separated into two chapters: Chapter 5 covers access functions and Chapter 6 covers protocols and illustrations of escape functions.

In Chapter 1, material will be presented that will allow the reader to acquire the basics of an ABA approach to understanding human behavior. This edition provides an analysis of the role of establishing operations (EO) and abolishing operations (AO) in the section of the first chapter titled “What Makes a Reinforcer a Reinforcer?” It has added material in this section to enhance a basic understanding of EOs and AOs as the “driving force” of any operant behavioral function. This third edition also has pulled out some of the theoretical material on unconditioned and conditioned EOs and AOs from the written text. Also, a section discussing the nature of contrived contingencies and their relation to behavioral function is presented at the end of Chapter 1. Understanding why contrived contingencies may work is important for behavior analysts who intervene at a group level, not just at an individual case level.

Chapter 2 allows the user to develop skills in collecting the requisite behavioral data needed for an FBA. Each step of data collection is detailed with multiple examples of hypothetical data provided for the reader. The analysis of EO variables in all the assessment methods is delineated in this third edition. All the same methods of functional assessment from the prior edition are clearly delineated in this edition as well. A useful addition for practice in this third edition involving a newly developed methodology for conducting a

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behavioral interview is presented: The Cipani EO School Behavioral Interview Form. This interview form will be particularly useful for practitioners as a starting point for discerning the problem areas and their antecedent and consequent factors. A form for ready use can be found in the relevant Appendix, with permission granted contingent on the appropriate reference credit given to this rating system in any report.

While this book provides content on FBA, not all applied problems in clinical settings require only an individual analysis of behavioral function. It can often be the case that problem behaviors are generated by the systemic contingencies that are misdirected. The last part of Chapter 2 involves a presentation of an ecosystemic assessment within classrooms to determine if classroom contingencies might be at the heart of a referred student’s problem behavior. By conducting such an assessment, the behavior analyst might uncover systemic contingencies that do not facilitate student or client performance, which allow other contingencies that detract from such to flourish. For example, in a classroom, one might find that a system that provides powerful reinforcers for academic performance is lacking. The installation of such a class-wide reinforcement system across the group would significantly alter performance problems in the target student and others.

Chapter 3 covers the four major categories of the Cipani Behavioral Classification System, a unique function-based, diagnostic classification system for problem behavior. This system provides a distinctive numbering system for delineating major diagnostic categories as well as subcategories within each major category. There are many illustrative real-life examples from my own experience and the experience of my former coauthor, Keven Schock, as well as hypothetical examples, which are drawn again from our decades of clinical experience.

Chapter 4 covers the identification of the replacement behavior and the delineation of a number of replacement function options for each major function. It provides multiple examples of how each differential reinforcement strategy is used for the particular major function. This edition also introduces the concept of a replacement function. Some of the treatment options cannot be defined as a behavior (e.g., tolerance training). This change in nomenclature allows for a more encompassing term to fit such phenomena.

Chapter 4 also presents a method for evaluating potential extinction bursts and their severity and length via a trigger analysis. The Cipani Diagnostic Classification System of Replacement Function, a unique, three-category classification system for determining the current strength of the replacement behavior(s), is presented at the end of Chapter 4. This section includes a presentation of the behavioral criteria for each classification. It also provides analogue experimental tests to determine whether a misdirected contingency diagnosis or inept repertoire diagnosis best explains why the replacement behavior/function is at low or nonexistent levels. With permission, Appendix B is taken from the book Triumphs in Early Autism Treatment (Cipani, 2008). It provides an analysis of persistent error patterns through the findings of basic research in stimulus overselectivity.

Chapters 5 and 6 provide the same compendium of behavioral treatment protocols as the earlier edition. A hypothetical example taken from the previous chapters is used to illustrate how all the phases are linked in designing a functional treatment. Each functional treatment program follows a uniform format in Chapters 5 and 6. First, we present a brief description of the procedures involved, as well as definitions of terms. Next, we delineate the procedures for collecting baseline data, and we present the procedural components of the treatment. Finally, we present a hypothetical example illustrating the application.

A Note to Instructors: Third Edition Changes There are significant pedagogical changes in this edition to the text and supplemental material to make it more amenable for university-training programs in applied behavior analysis, school psychology, and special education teacher training. Here are some of the changes in this third edition that will enhance student learning of applied skills for teaching faculty.

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Chapter Objectives and BACB Tasks Addressed At the beginning of each chapter, the list of objectives addressed in each chapter appears. This should allow the instructor to match these up with the fourth and fifth editions of the BACB (2013, 2017) task lists tasks addressed in the chapter are provided below the chapter objectives) or other such accrediting agencies’ specifications. Word files of this material as well as other information that may be helpful in building a course syllabus is available to qualified adopters in the password protected instructors resources.

Narrated Lectures and Text-Embedded Assignments References to related online lecture presentations are embedded in the text and highlighted by this icon, placed in the margin of the page. Such lectures are accessed via Springer Publishing’s website (www.springerpub.com/fbadt) with lectures clearly marked with the name delineated in the text under the icon. The content of the lectures covers additional material as well as applied demonstrations of FBA and functional treatment with diverse clinical and school populations in various settings. The specifics of the assignment are demarcated in the text below the special icon signifying narrated material. The criteria for each assignment are delineated and may serve as rubrics for grading purposes. Chapter 1 has one assignment, Chapter 2 contains three assignments, Chapter 3 has two assignments and Chapter 4 contains three assignments.

Simulation Exercises A format for classroom exercises that simulate some of the assessment methods (e.g., Chapter 2) in the text is delineated. These practice exercises can be performed in class to facilitate students’ acquisition of actual skill in data collection and the conduct of the designated assessment and its procedures. The specific method for providing the classroom simulation is presented under the caption where indicated. There is also a simulation found in Chapter 1; it provides demonstrations of the four major functions. A simulation exercise in Chapter 4 allows students to observe how to “shape” an alternate behavior involving an appropriate request or protest (termed mand).

Chapter 1 ll Type of access or escape function

Chapter 2 ll Data Recording ll Trigger analysis of access functions ll Trigger analysis of escape functions ll Analogue assessment

Chapter 4 ll The “Yes” game

Discussions Discussions of the presented content are embedded throughout the text in the first four chapters. This inserted material can be used for class discussions (make sure students bring their texts to class to refresh their memory) or as online discussion threads.

ll Chapter 1: 1A–1D ll Chapter 2: 2A–2F ll Chapter 3: 3A–3H ll Chapter 4: 4A– 4F

www.springerpub.com/fbadt

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Using Chapters 5 and 6; Signature Assignment The protocol material in Chapters 5 and 6 allows the reader to view the longitudinal conduct of an FBA, diagnostic classification selection and design, and implementation of functional treatment with hypothetical cases. We recommend that faculty using this book save this chapter for the end of the course, and that the material be used to develop case-presentation skills (possibly the signature assignment). Each student can be assigned (or choose) a given protocol for study and prepare a case presentation in front of the class. In these presentations, the student steps into the “role of the teacher or therapist” of the particular hypothetical case and covers the following in a half-hour to one-hour oral presentation:

ll Presenting behavior problem ll Analysis of “why”—hypothesized function of problem behavior and relevant

classification category ll Data collection from assessment method used and results ll Functional treatment developed and deployed ll Treatment results ll Summary (why did it work)

In many cases, the graduate students in the course do not have access to students with challenging behavior in which to conduct an actual FBA. Or often, privacy and confidentiality issues, as well as legal issues involving the parents and IEP team’s school personnel consent to conduct such an assessment, preclude such an assignment to students. Hence, a signature assignment involving real-life data collection is frequently precluded. In those circumstances, the earlier case presentations are an approximation of the genuine longitudinal process of assessment–classification–treatment personnel conduct with actual students requiring an FBA.

Instructor’s Resources The password protected online instructor’s resources are available to qualfied adopters upon request. Instructors will find the following:

ll An extensive slide presentation for each chapter is available. It contains “presentation units” within each chapter that cover a section of the chapter’s content in the slide presentation. Each presentation unit is followed by slides that pose questions from both the slide material as well as the text. This facilitates “active student engagement and responding.” The questions are generally short answer. Students can convey their responses to such questions in any number of mediums deemed viable by the instructor (dry erase boards, paper, vocal responses, etc.). It is therefore important that students bring their text to class to be able to address such questions that are derived from the text. This format will also facilitate more active student engagement in the instructor lecture with the PowerPoint slides. If you do not desire such slides they can always be hidden using the tool in the main navigation bar.

ll A pool of chapter test items (multiple-choice and true/false items) that are separated into areas of content within each chapter (e.g., items measuring student’s comprehension of analogue assessment methods)

ll Measurement items (short answer) for determining student competency with each chapter objective

ll A narrated presentation detailing the supplemental materials and suggestions for use ll “Modularized” chapter PowerPoint slide presentations with group answer test items

(called active student responses or ASRs) within each module section

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ll Course Syllabus Builder: provides Word files that can be copied and pasted to develop many of the components required in a course syllabus, such as: l° Brief descriptions of each chapter l° Chapter topics l° Chapter objectives and BACB task lists for each chapter l° Assignment details and rubrics for scoring (including signature assignments)

ll “What to Read if You Used the Second Edition,” a conversion guide for current adopters highlighting changes between the second and third editions

Student Resources Supplemental lecture videos and PowerPoints are available to students to help further clarify key concepts reviewed in the text. Students can access the additional material by visiting http://www.springerpub.com/fbadt.

REFERENCES Bailey, J. S., & Pyles, D. A. M. (1989). Behavioral diagnostics. In E. Cipani (Ed.), The treatment of severe behavior disorders: Behavior analysis approach (pp. 85–107). Washington, DC: American Association on Mental Retardation. Behavior Analyst Certification Board. (2013). Fourth edition task list. Retrieved from https:// bacb.com/fourth-edition-task-list Behavior Analyst Certification Board. (2017). Fifth edition task list. Retrieved from https:// bacb.com/wp-content/uploads/2017/01/170113-BCBA-BCaBA-task-list-5th-ed-english.pdf Cipani, E. (2008). Triumphs in early autism treatment. New York, NY: Springer Publishing. Cipani, E., & Cipani, A. L. (2017). Behavioral classification system for problem behaviors in schools: A diagnostic manual. New York, NY: Springer Publishing. Cipani, E., & Schock, K. (2007). Functional behavioral assessment, diagnosis, and treatment: A complete system for education and mental health settings. New York, NY: Springer Publishing. Cipani, E., & Schock, K. (2011). Functional behavioral assessment, diagnosis, and treatment: A complete system for education and mental health settings (2nd ed.). New York, NY: Springer Publishing.

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I want to thank my co-author of the first and second edition of this text, Keven Schock, BCBA, for his contributions to the previous and current material. The actual cases he presents in this 3rd edition will be denoted via his name. The functional behavioral diagnostic system delineated in this text are an outgrowth of our collective experience in clinical and teaching positions over several decades. An earlier version of this system, called the Cipani Behavioral Assessment and Diagnostic (C-BAD) System, provided us with feedback and input from many behavior analysts who utilized that system in the 1990s. Such feedback improved the basic concepts and instructional content presented in the first edition. In particular, the authors would like to recognize Dr.  Heidi Toro of the Florida Department of Children and Families, Dr. Merrill Winston of Professional Crisis Management, Dr. Steve Eversol of Behavior Development Solutions, and Mr. Chris Clay of the Community Re-Entry Program for their valuable suggestions over the years. Our association with them has allowed us to improve our analysis and presentation of the conceptual and methodological model that embodies the current form. Finally, I  wish to thank Dr. Jose Martinez-Diaz of the Florida Institute of Technology for making the distinction between motivative variables and discriminative stimuli more clear to me.

Acknowledgments

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1Basic Concepts and Principles

Objectives

• Students will be able to describe and provide an illustration of a direct access function

• Students will be able to describe and provide an illustration of a direct escape function

• Students will be able to describe and provide an illustration of a socially mediated access function

• Students will be able to describe and provide an illustration of a socially mediated escape function

• Students will be able to identify an establishing operation for a number of access functions as one of a state of deprivation

• Students will be able to identify an establishing operation for a number of escape functions as one of a presenting state of aversion

• Students will be able to discuss what a contrived contingency is and how it can “override” existing motivational variables

Chapter 1 Behavior Analysis Certification Board (BACB) Task List

4th edition 5th edition • FK-01 Lawfulness of behavior

• G-04 Explain behavioral concepts using nontechnical language

• E-01 Use interventions based on manipulation of antecedents, such as motivating operations and discriminative stimuli

• B-4 Define and provide examples of positive and negative reinforcement contingencies.

• B-5 Define and provide examples of schedules of reinforcement.

• B-6 Define and provide examples of positive and negative punishment contingencies.

• B-7 Define and provide examples of automatic and socially mediated contingencies.

2 Functional Behavioral Assessment, Diagnosis, and Treatment

WHY DOES HE DO THAT? Why does he do that? This is the age-old question that people ask when they see a child throw a fit in public. Why does he behave like that? To date, an often-cited explanation of such undesirable behavior involves a hypothesis about the brain’s development in the child who is “afflicted” with such behavior. The underpinning of the undesirable tantrum behavior is hypothesized to be the result of some abnormality or underdevelopment of some part or parts of the brain. As further evidence of brain involvement, in some cases, such behavior along with other behaviors form the basis of a mental disorder. Following is an excerpt from a hypothetical lecture in a child psychology class.

Student: Dr. Trait, I have a question. Why do some children have tantrums that are clearly inappropriate for their age?

Dr. Trait: The child throws the tantrum because he or she is immature for his or her age; the brain has not fully developed. Once the brain matures—particularly the frontal lobe, which is responsible for executive functioning—the child will not respond to social situations in that manner. Until that point, we can expect this child to continue behaving in such a fashion because of his or her inability to process events adequately. Teenagers have a similar problem with brain immaturity when they behave impulsively. Their brain is not like the adult brain; hence, they too cannot be fully responsible for their impulsivity.

Variations and extensions of this immature brain explanation exist. The following is a continuation of this conversation in a class in developmental psychology, with a slightly different explanation.

Student: In Dr. Trait’s class, we were told that children who have severe tantrums that are clearly inappropriate for their age do so because their brain is not fully developed. Is there any experimental cause-and-effect evidence for such an assertion?

Dr. Stager: Well, I believe there is more to it than just the brain’s development, although I would concur that neurological issues are part of the problem. Children behave in a certain manner because they have not proceeded through certain invariant developmental stages. I would say that these children have not progressed past the egocentric stage. Of course, once the brain has developed, it is more likely that these children will interpret the actions of others as reasonable and not view everything from a “me first” perspective. When this happens, these children will not react in such a manner, but will respond to conflict in a more age-appropriate way.

Suppose we believe that the child throws a tantrum because the brain is not yet fully developed. What are the ramifications of dealing with such behavior when the supposed cause is brain malfunction? Do we wait until the brain becomes more fully developed? For clients who have continued such “immature” behaviors throughout their adolescence and into adulthood, do we still continue to wait? What can be done in the interim to reduce the child’s tantrums and develop a more acceptable manner of dealing with his or her social environment?

What is wrong with these interpretations about tantrum behavior? The role of the environmental response to such behavior is trivialized. If the brain has not developed, apparently what people do in response to the child’s behavior, whatever the form, is insignificant and, therefore, irrelevant. One can only hope that the child’s brain becomes more fully developed. We believe there is a better conceptualization of why tantrum behavior occurs.

Instead of saying that the child throws a tantrum because he or she is immature, we would possibly ascribe such an incident to the purpose or function such tantrum behavior serves in that child’s environment. That conceptualization would generate an examination of observable events in the social environment. In the case of a child’s tantrum behavior, one would examine what the social environment does when the child has a fit in public. What is the antecedent context for such tantrum behavior? How does the social environment

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1 Basic Concepts and Principles 3

react to these tantrums in the short and long term? This examination of temporally ordered environmental events can reveal the purpose of this behavior in this context.

This approach is termed a functional behavior-analytic approach to understanding human behavior (Bailey & Pyles, 1989; Cipani, 1990; Cipani & Trotter, 1990; Iwata, Vollmer, & Zarcone, 1990; LaVigna, Willis, & Donnellan, 1989; Lennox & Miltenberger, 1989). In a functional behavior-analytic approach, all operant behavior is viewed as serving an environmental function, either to access something or to terminate/avoid something (not withstanding genetic influences for some behaviors). Although other psychological explanations invoke hypothesized traits or developmental stages to explain behavior, a functional behavior-analytic viewpoint examines the roles of both the social and physical context—it deals with events that are both observable and measurable.

A hypothetical 7-year-old child named Oskar, diagnosed with oppositional defiant disorder (see the Diagnostic and Statistical Manual of Mental Disorders [5th ed.]; DSM-5), has extreme oppositional behavior with occasional aggressive behavior. Explaining such behavior as a result of his disorder is sufficient for many mental health professionals. When asked why this child has such episodes, their response would be: “It is a symptom of his underlying disorder—oppositional defiant disorder. He behaves in an extreme fashion because he has this disorder.” As you can see, this is a trial lawyer’s dream. People do things because they have a disorder. If they have this disorder, they cannot help it.

Whenever this form of behavioral episode occurs, it is the disorder that made him do it and he will engage in such behavior from time to time. It further presumes that such a behavior will occur irrespective of context and consequences. The child engaged in the defiant and/or aggressive behavior because of his malfunctioning brain. Such brain malfunctions are not predicated on the presence of any environmental context. One never knows when the neurons misfire; when they misfire, defiant and aggressive behavior results.

In contrast, a functional behavior-analytic view would explain such behavior more from the social (and sometimes physical) context of the behavior. One would examine Oskar’s history of oppositional and aggressive behavior and how such behavior alters his existing social environment. An understanding of why the behavior occurs is accomplished through an analysis of the behavior’s ability to either produce desired events or terminate undesirable events.

For example, we may discover that Oskar often engages in such behavior when he comes home from school. Oskar’s mother wants him to stay in the house for a while and either do his homework or finish cleaning his room. Oskar, of course, wants to go outside and play with his friends. He sometimes will complain and whine. His mother will respond to such complaining with the following retort: “You need to finish your homework. How do

WHY IS TRADITIONAL COUNSELING OFTEN NOT EFFECTIVE WITH MANY CHILDREN WITH SEVERE PROBLEM BEHAVIORS?

In 2016 many people believe that sending children with severe problem behaviors to counseling is the best method for changing these behaviors. Can anyone (through counseling) convince Oskar that aggressive behavior is not in his best interest? What is in a child’s best short-term interest when he is placed in time-out? It is getting out of time- out. As a reader of these materials, do you believe that talking to Oskar once or twice a week will convince him not to behave aggressively toward his mother when he is told he cannot go outside?

How will Oskar’s behavior change? Ultimately, it is up to the care providers and parents to change their own behavior in order to change the child’s behavior. If Oskar’s mother continues to handle this situation in the same manner, I cannot see where anyone can convince him to respect his mother’s wishes and do his homework before going outside. In a functional behavioral-analytic approach, the presenting problem is not just with the child. It is also with the way the child’s environment responds to his behavior.

You change child behavior by changing the behavior of the adults who deal with that child. Pure and simple!

4 Functional Behavioral Assessment, Diagnosis, and Treatment

you expect to pass third grade? Once you are done with your homework, then you can go outside.” This parental response to his behavior incurs more arguing and defiance from him, with refutations for each assertion by his mother. When Oskar sees that this verbal battle with his mother is not helping his cause (i.e., getting to go outside), he tries another tact. He states, “I’m going to leave and you can’t stop me.” When he begins to exit the house, she grabs him. At this point, he yells at her, calls her names, and hits her. After a struggle, Oskar pulls away and heads out the door. His mother, tired of fighting with her son, lets him go, complaining he is just like his father.

With this information, what is a more plausible explanation for Oskar’s behavior during these circumstances? Does he act out because he is disordered? Or does the explanation lie in an understanding of how such a behavior impacts his environment? Does less intense arguing with his mother result in him going outside? Or does he get to go outside when he becomes assertive (walking to the door) and combative (when he hits his mother as she tries to get him to stay inside)? What is the best explanation for Oskar’s aggressive behavior in the afternoon? He does it because it “works” for him when he wants to go outside, and other behaviors such as complaining are less effective. The function of such combative and aggressive behavior provides an explanation of why it occurs. Such an explanation can be experimentally demonstrated, as you will find out in the coming pages of this book.

THE CORNERSTONE FOR UNDERSTANDING WHY In a functional behavior-analytic approach, behavior is viewed as functional (i.e., purpose- ful) for certain antecedent contexts because of the contingency or contingencies involved. Simply stated, behavior always makes sense, from the standpoint of the person exhibiting such behavior. A contingency is the temporal relationship between behavior and a consequence. It is often stated as an “if, then” rule. If you get an A on your quiz, then I will take you out for ice cream. If you stick your hand in the door and it closes on your hand, then you will experience pain and yell loudly. Such social and environmental consequences influence whether the behavior that produces them will become more or less probable in the same or similar context.

For example, the manner in which Oskar’s mother responds to his mild complaining behavior makes that behavior ineffective. If Oskar wants to go out, and he complains, it seems that such behavior is not instrumental in getting him outside in the immediate future. Therefore, mild pleading and complaining behavior becomes less likely in subsequent afternoons when Oskar wants to go outside. The current arrangement between complaining and not getting to go outside makes such forms of complaining a less viable alternative in these circumstances.

However, the story for verbal defiance and physical aggression is quite the opposite. These behaviors, including defying her wish to stay inside by physically leaving, are functional in accessing the desired event. The next day, when Oskar’s request to go outside is denied, what would he likely do? You guessed it. If Oskar’s mother continues to respond to her son’s defiance and aggression in the same manner, such behaviors become functional in that context. If this relationship between aggressive behavior and going outside becomes strengthened, under certain motivating and antecedent conditions, then such a relationship defines a maintaining contingency or behavioral function. There are two major types of behavioral functions for problem (or other) behavior: positive reinforcement and negative reinforcement.

BEHAVIORAL FUNCTIONS INVOLVING POSITIVE REINFORCEMENT (ACCESS FUNCTIONS) Positive reinforcement functions involve behaviors that produce an environmental event that subsequently increases the likelihood of that behavior under the same or similar antecedent motivating conditions. In other words, the operation of positive reinforcement involves

Why does he do that!

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1 Basic Concepts and Principles 5

a behavior that produces an event (activity, object) that subsequently strengthens the occurrence of that behavior in the future (under certain motivational contexts). As a result of such a behavior-contingency relationship, the behavior becomes functional under given motivating conditions (to be discussed in greater detail later in this chapter). For purposes of the function-based diagnostic system delineated in Chapter 3, positive reinforcement functions are termed access functions, that is, these behaviors access preferred items, events, or activities.

What are some hypothetical illustrations of access (positive reinforcement) functions? Milton, an inpatient client with schizophrenia, is reported to frequently pinch other clients. Is this pinching behavior the result of his schizophrenia? Is it the result of his inability to control his impulses? I believe neither explanation would serve a useful or parsimonious purpose. After some duration and frequency (to be explained in Chapter 2), when Milton pinches others we find that staff take him for a walk. Their rationale for such a response to his pinching is that they want to get him away from other clients. They report that Milton seems to be less anxious when he is on his walk and that the walk calms him down. Facility staff, thereby, interpret their use of a walk as an “anxiety-reductive procedure” and believe that this practice is clinically sound. However, what escapes them is the long-term result of this reliable contingency between what Milton does and what they do. Milton has learned how to get a walk with staff—pinch someone! We would say that pinching other people is a functional behavior when Milton desires a walk. Unfortunately, other more appropriate behaviors do not appear to be more effective (i.e., less functional) in getting a walk. The behavior of pinching others subsequently increases to a level that constitutes a major problem, which now jeopardizes Milton’s ability to remain in the current inpatient unit.

Bea, a residential adult female client, throws a tantrum (consisting of screaming and slapping herself) at certain times during the day. Bea’s tantrum behaviors are reported to consist of yelling, hitting or slapping herself, calling staff profane names, claiming she was placed in this facility by the Mafia, and making verbal threatening statements to staff and other residents. When she engages in such behavior for a period of time, one can observe staff members give her something to eat. These staff members interpret her behavior, after some duration, as a sign that she is hungry. Of course, feeding her certainly stops the threats made to them and others. Although feeding Bea may produce the desired short-term result, it creates long-term disaster. Such tantrum behaviors become more probable for Bea when she is relatively hungry (or at least when she wants certain food items). You might conclude that Bea’s tantrum behavior is maintained because it is capable of acquiring food when she is hungry. Bea may also learn to engage in the same type of tantrum behavior when she wants her CD player and is told she has to wait until after dinner for it. If such behavior reliably results in Bea getting the CD player before dinner, then tantrum behavior also becomes functional under the conditions of Bea desiring the CD player. We would expect an increase in the frequency of tantrum behavior across the next few weeks as it becomes strengthened as a functional behavior when she desires the CD player.

A 4-year-old child named Elvira, diagnosed with autism, will engage in screaming and hitting herself multiple times during the day. Many people will explain such behavior by referring to her developmental disorder. They will proclaim, “Elvira throws a tantrum because she has autism. Her autism is the cause of this behavior.” But is this really a good explanation? Can one predict that all children with autism will engage in such behaviors independent of social context? Does such behavior differentiate children with autism from children with other developmental and/or mental disorders (i.e., only children with autism hit themselves)? If such behavior is caused by autism, what options remain for the successful treatment of such behaviors, ameliorating or eliminating autism? Although eliminating or curing autism is certainly a laudable goal, is it reasonable to suspect that this will occur in time to help Elvira before she enters school? Before she becomes an adult?

A more productive and functional approach focuses on the environmental function (i.e., outcome) of problem behaviors. For Elvira, screaming might reliably access parental attention, or hugging, under conditions in which she desires such activities or events. When Elvira desires parental attention because it has been some time, tantrum behavior becomes

6 Functional Behavioral Assessment, Diagnosis, and Treatment

more probable. The production of attention for some level and duration of tantrum behavior then maintains Elvira’s behavior as functional in accessing attention.

BEHAVIORAL FUNCTIONS INVOLVING NEGATIVE REINFORCEMENT (ESCAPE FUNCTIONS) Although many people are familiar with positive reinforcement, negative reinforcement is often misunderstood (Cipani, 1995; Cipani & Spooner, 1997; Iwata, 1987). An understanding of negative reinforcement operations is critical to the design of effective treatments, particularly if you serve individuals who often engage in behavior problems during task demands, compliance situations, instructional conditions, or chores and work tasks.

In negative reinforcement, the effect of the behavior is to terminate the existence of, or postpone (for some time), the presentation of a stimulus condition or event. Such an event is commonly referred to as aversive or unpleasant (relative to the individual). Realize that the term “aversive” is relative. What is aversive to one person may not be to another; what is aversive today may be less aversive next week. The subsequent effect of a negative reinforcement contingency on behavior is one of increasing its probability under the same or similar conditions in the future. Negative reinforcement functions are called escape functions (includes avoidance functions in this terminology).

Examples of escape functions with problem behavior can be used with the previous hypothetical cases by altering the behavioral effect of the problem behavior. For example, Bea is asked to clean up her room. She will often refuse such an initial request. When staff persons at the facility warn her that she will not get to watch television that night, she screams and yells at them. After an intense episode, Bea sometimes gets put in time-out and loses her television privileges. However, with certain staff persons, if she promises not to raise a commotion, the staff person will clean up Bea’s room for her so she can watch television. Such a behavioral effect subsequently increases the probability of Bea screaming in those conditions (or similar conditions) in the future.

Can pinching people occur for a different reason than wanting a walk? Let us say that Milton also pinches people when he is asked to go to group therapy (which he finds aversive). What is the “reason” or function for pinching when confronted with this request? Suppose the following events play out when Milton pinches a staff person when it is time to go to group therapy. When he pinches a staff person, someone decides that he should be taught that this is wrong. Milton should be put in time-out to teach him that pinching is inappropriate. The staff keep him in time-out until he is quiet and is able to say he is sorry for pinching the staff person. His apology does not occur readily and the minutes go by. By the time Milton is allowed to leave time-out, his group’s therapy hour is almost over. He therefore is able to shorten his participation in group therapy by going to time-out and being adamant about his right to pinch people. Unfortunately, Milton does not learn the “lesson” that the time-out was intended to teach, and instead it intensifies his pinching behavior before group therapy. One staff person remarks that it almost seems as if Milton pinches to avoid going to therapy, but others quickly dismiss such a contention.

As a result of this imposed time-out consequence for pinching, Milton is pinching more often when it is time to go to group therapy. Consequently, he misses most therapy sessions in a given week. Can you see why he is pinching when it is time to go to therapy? Pinching avoids an activity Milton dreads—going to group therapy. As a side note, it might be interesting in this case to find out why Milton does not like to go to group therapy (i.e., what does he wish to avoid) in order to solve this behavior problem in the long term. Beyond that, one might question why he should go to group therapy. If it was to help him uncover the reasons for his pinching mode of interaction, we could now dispense with such a requirement (given its obvious lack of effectiveness).

Another example illustrating a negative reinforcement function is the self-abusive behavior of a child with autism spectrum disorder (ASD). As a general note, very often

1 Basic Concepts and Principles 7

in classroom situations, problem behaviors such as self-abuse can often function to avoid or terminate instruction. Hence, under such conditions certain behaviors become very “adaptive.” This child hits his or her head with an open hand or closed fist, and such behavior often seems to occur during group instruction. Consequently, the teacher will often stop instruction or remove the child to deal with the self-abuse. Self-abuse becomes functional in lessening or avoiding such a context.

Unfortunately, self-abuse is often unintentionally exacerbated. If staff reason that the child hits him- or herself for their attention, they might conclude that ignoring this behavior will make it decrease and eventually disappear. When the function of this child’s self-abuse is misdiagnosed as attention seeking, ignoring minor forms leads to more disastrous forms of behavior. As a result of staff ignoring minor forms of self-abuse, the severity of the self- injury intensifies. The more severe head hits do result in the instruction being halted for a period of time. Consequently, more severe self-abuse becomes prevalent, as a result of its ability to effectively terminate instruction. Perhaps, at the beginning of the year, the teaching personnel reported to the individual education plan (IEP) team that this child does engage in self-abuse, but they can handle it. Of course, this was under the presumption that their ignoring strategy would work. Now, at mid-year, this child may no longer be suitable for this classroom because the self-injury has resulted in a broken nose and gashes on the forehead. The child may now require a placement where a more intensive behavioral approach is available. A minimal problem has developed into a major threat and hazard to this child’s health and educational welfare.

CONTRASTING ACCESS AND ESCAPE FUNCTIONS Table 1.1 provides more examples of behaviors that illustrate access (positive reinforcement) functions. Note that in all instances the effect of the reinforcement contingency is one that strengthens the behavior that produces the desired event. Table 1.2 illustrates how behaviors that previously accessed desired events now function to terminate aversive events. We conclude that the form of the client’s problem behavior does not usually give a clue as to behavioral function. Hence, a diagnostic system that focuses exclusively on symptoms to differentiate clients misses the mark.

Comparing Tables 1.1 and 1.2 provides an illustration of how the same behavior can produce different environmental effects, that is, consequences that maintain such behaviors.

www.springerpub.com/fbadtBA MODEL OF CHILDHOOD AGGRESSION Assignment: A Behavior-analytic model for explaining childhood aggression (see hot link in student portal; www.springerpub.com/FBAStudents)

After reviewing the lecture entitled, “A behavior-analytic model of childhood aggression,” submit a paper addressing the following questions in order:

• What is the behavior-analytic explanation for the possible etiology or cause of child aggression? How is that different from a traditional explanation? (See “Why Does He Do That?” section at beginning of chapter.)

• What is the behavior-analytic explanation for the continued display of child aggressive behavior over time?

• How do contrived punishment contingencies (adult-imposed) for aggressive behavior affect its function?

• Does watching or observing aggression explain the latter (i.e., how young children who are aggressive engage in such behavior when they are adolescents)?

8 Functional Behavioral Assessment, Diagnosis, and Treatment

Note that the behavior (although the same form of response) produces two different outcomes. In the third example in Table 1.1, the behavior of Bobby hitting his brother resulted in his mother intervening and giving him the toy that his brother had. If hitting reliably results in mom’s mediation of the conflict via giving in to Bobby’s desire for some object or item, hitting becomes more probable when Bobby wants something his brother has.

In contrast, in Table 1.2 note how hitting serves to remove an aversive stimulus for the same topography (form) of behavior. Bobby hitting his brother makes his brother leave

TABLE 1.1 n EXAMPLES OF ACCESS FUNCTIONS

Behavior Contingency Produced Effect of Contingency on Behavior

Child cries Gets cookie Increases likelihood of crying when child wants cookie in the future

Man on inpatient unit stomps foot on floor, kicks wall

Gets nurse to come over and give social attention, engage him in pleasant conversation

Increases likelihood of such behaviors when man wants to socially interact with that nurse in the future

Child hits brother Mom tells brother, “Give Bobby the toy; he is not as mature as you are” and gets toy

Increases likelihood of aggression when child wants some toy or item his brother has

Student says, “This is not fair, I never get a turn”

Teacher gives child a turn on tetherball

Increases likelihood of such demand/tantrum behaviors when child wants to get tetherball or other activity and does not want to wait for peers to give him or her access

TABLE 1.2 n EXAMPLES OF ESCAPE FUNCTIONS

Behavior Contingency Produced Effect of Contingency on Behavior

Child cries Released from “room time” Crying is more likely when child is placed in room for discipline

Man on inpatient unit stomps foot on floor kicks wall

Gets nurse to leave him alone for a while instead of taking his medication

Such aggressive behaviors are more probable when nurses are trying to get this man to do something he does not desire

Child hits brother Brother leaves room Aggressive behavior becomes more probable when this child wants to be left alone

Student screams, “This is not fair, I always get more work”

Teacher talks to student, agrees to reduce assignment by half

Increases likelihood of such demand/tantrum behaviors when child wants to do less (or no) work

1 Basic Concepts and Principles 9

the room. Hence, whenever, Bobby wants to be alone without his brother in the room, to what behavior will he now resort? Hitting! To summarize, hitting that occurs under the context of his brother playing with a toy that he wants functions to get the toy via mediation of such behavior by his mother. Hitting that occurs when Bobby wants to be alone results in the removal of the unwanted party via the brother leaving the room. This is the same behavior with two different functions.

Compliance situations can be a context where problem behaviors arise. There are two types of commands (Neef, Shafer, Egel, Cataldo, & Parrish 1983). One type involves a parent issuing a request or directive toward a child to engage in some requested behavior (called a “do” command). The contrasting type of command involves a request to desist a behavior (called a “don’t” command). Examples of compliance situations involving a do command are (a) “pick up your trash and place it in the trash can,” (b) “open the door to the laundry room,” (c) “put your sneakers on.” Examples of don’t commands are (a) “stop running through the hallway,” (b) “stop yelling,” (c) “do not throw the ball against the house again.” When oppositional behavior occurs in compliance situations (i.e., the child refuses to follow through with the request), it can be analyzed in terms of function (Cipani, 1998).

In some cases, noncompliance takes an innocuous form, such as the individual simply not attending to the person issuing the command. Such a lack of response is maintained by negative reinforcement, that is, avoidance function. A command is issued and the child or client does not respond but rather continues engaging in the ongoing activity. The form of noncompliance at this moment is simply nonresponding. If the adult making these requests often forgets about what task was requested as a result of inactivity on the part of the client, one can see that nonattending avoids engagement with task.

With some children or clients, their opposition to the request or command entails more than just ignoring the request. In many home and school compliance situations, the child is “forced” to engage in other forms of protest to successfully avoid engaging in the undesired task. Let us say that the adult fails to leave them alone when they simply opt out of complying with the request peacefully. The response of the adult to the child’s deaf ear approach (i.e., adult issues request again) does not provide escape from the compliance situation. When the adult responds with another request the child now retorts, “I’m not doing it!” Because simply ignoring the request did not work, maybe becoming insolent and disrespectful at the person making the request will force the adult to leave the child alone. The form of noncompliance can then become exacerbated, as mild forms of opposition do not have the effect desired (i.e., termination of the request). To illustrate this point, following is a hypothetical scenario with an adult client in a group home.

Staff member: Mr. Smith, please pick up your dirty clothes from the floor and place them in the hamper.

Mr. Smith: Leave me alone. I’m watching American Idol. Staff member: Mr. Smith, I need you to pick up your clothes. Someone may trip over

them when they are in the middle of the day room. Mr. Smith: Then that would be their own stupid fault! Staff member: (Moves closer to Mr. Smith) Mr. Smith, would you like me to help you? Mr. Smith: I would like you to leave me alone! If you are so interested in my dirty

clothes, you pick them up. Staff member: Please address me with respect. Mr. Smith: Quit ragging on me, you . . . . Staff member: Okay, Mr. Smith. I will get Raul and Robert to help me assist you. Mr. Smith: (Gets up and runs out of the day room with staff in tow. He hides in the

bathroom and does not come out. After 25 minutes, he finally opens the door and is allowed to go back and watch television with the clothes now having been picked up by someone else.)

10 Functional Behavioral Assessment, Diagnosis, and Treatment

Note that in this scenario, simply protesting was not an effective method of being left alone. Such behavior resulted only in continued verbal requests on the part of the staff member. However, with continued requests and the threat of having several staff members help him get his clothes off the floor, Mr. Smith engages in more than just noncompliance. He runs out of the room and locks himself in the bathroom, which of course makes picking up his clothes very unlikely. Do you think Mr. Smith will conclude that the bathroom is a good place to escape from staff?

WHY DO SOME CLIENTS ENGAGE IN SEVERE DESTRUCTIVE BEHAVIORS?

In some settings, clients engage in severe forms of self-injury, aggression to others, and property destruction. Many people take this as an example that these people have uncontrollable rages as a result of their disorder. “Obviously these people have no control over what they do. They are driven to destruction!”

Take the case of the previously discussed child who gets sent to the time-out room and cries to get “a more lenient sentence” once there. He might be judged to be less “disordered” than another child who engages in property destruction when placed in time-out. Why does he cry and not become destructive? Although this child currently does not engage in property destruction, he may not be far from learning how to do such. Here is a scenario of how more severe tantrum behaviors can be shaped by the social environment.

Suppose his parent decides to ignore the tantrum behavior in the time-out area. He will “stick to his guns” and not allow his child to get out early. The child goes to time-out and begins his crying episode but to no avail. He cries louder, but that does not result in removal either. He then throws something at the wall. The parent then comes into the room to find out what has happened. Note the effect of the throwing behavior in the sequence of events. If crying does not work, throw something. That will bring in Dad, and possibly a reprieve!

With time, the parent ignores some of the throwing episodes until a shoe goes through the dry wall near the door. As you can see, with each new exacerbation of behavior, the parent “has to” attend to the child to stop any further escalation. Hence, months later the child is now destroying the room, as opposed to just crying when placed in time-out.

DIRECT VERSUS SOCIALLY MEDIATED CONTINGENCIES There are two ways to access positive reinforcers: directly and socially mediated. Escape behaviors can function to produce the termination of an aversive event in the same two ways: directly and socially mediated. Hence, there are four possible major functions (Table 1.3).

Direct Access (DA)1 With a direct access function (referred to in the behavior analysis literature as automatic positive reinforcement), the client’s behavior immediately produces access to the desired

TABLE 1.3 FOUR MAJOR FUNCTIONS

Two Access Functions Two Escape Functions

Direct access (DA) Direct escape (DE)

Socially mediated access (SMA) Socially mediated escape (SME)

1 Basic Concepts and Principles 11

event or item (Cipani, 1990, 1994; Michael, 1982; Vargas, 1988). For example, an individual is hungry and goes to the refrigerator, opens the door, selects an apple, and eats it. This chain of behaviors directly produces the apple. We would not say that the individual exhibits those behaviors because of the attention someone gives to him or her, regardless of whether such attention is positive, negative, or neutral. Attention would be a tangential consequent event. Getting the apple is the desired reinforcer. This is an example of a direct access function; the sequence of behaviors produced the bite into the apple directly.

What are some other examples of direct access functions? Putting the key in the car and turning it (behavior) when one wants to get across town produces the desired result (car starting). Lying down on the bed (when one is tired) involves a chain of behaviors that directly produces the reinforcer (rest). It is important to note that these behaviors produce the reinforcer immediately and directly.

How many people do you know who sing in the car while driving to work? Or sing in the shower? What “motivates” this behavior? Does someone reinforce this behavior with attention? Probably not! Their behavior is maintained as a result of the direct environmental effect produced, that is, the sound (hopefully of a somewhat melodious nature). Particularly in the shower, the sound reverberation can be sensorial reinforcing. Such singing behavior in the absence of an audience is reinforced because it produces an immediate inherent pleasurable sensory outcome that is desired at that time.

Too often, personnel assume that the problem behavior is maintained because of what people do after the behavior (called social mediation). But some instances of problem behavior are not “driven” by the desire to obtain attention, but rather are the result of the effectiveness of such behavior in directly producing the reinforcer. Here is a great real- life example. A client in a residential facility for persons with developmental disabilities jumps out of a wheelchair with some frequency (J. S. Bailey, personal communication, 1989). On one of these jumps, he falls to the ground, and his head begins to bleed. Obviously, the behavioral treatment program needs some adjustment! The facility calls in a nationally recognized expert in applied behavior analysis (Dr. Jon Bailey). Staff claim that the client jumps out of his wheelchair because he loves the medical attention he receives upon getting hurt.

What is the natural result of jumping out of the wheelchair? On some occasions, it does seem to be contusions and abrasions to this person’s body. However, the one result that always occurs is being on the floor (or, conversely, being out of the wheelchair). Every time this person pushes himself out of the wheelchair, he gets the freedom to roam around on the floor. Could sitting in a wheelchair for sometimes 12 to 16 hours a day, every day, be a motivational context for desiring “out of wheelchair” time? Any person who has driven a long time in a car or flown on a transcontinental nonstop flight may be able to relate. The problem with this behavior is not what the client wants but the manner in which he seems to have to access it. If this client was unable to verbally communicate his desire to staff, it would seem plausible that he would take matters into his own hands.

Socially Mediated Access (SMA) Other behaviors achieve their desired effect through the behavior being mediated by someone else (Cipani, 1990, 1994; Michael, 1982; Sundberg, 1983). These behaviors produce the desired positive reinforcer through the efforts and actions of someone else.

The following scenario utilizing the previous example can provide the contrast between direct access and socially mediated access functions. Previously, the individual wanting to eat an apple (the person is hungry) performed a chain of behaviors that directly produced the apple, hence a direct access function. The same behavioral effect can occur when the individual requests someone standing next to the refrigerator to hand him or her an apple. Note the different manner in which the apple is obtained. In the latter example, the requesting behavior is mediated by another person, and subsequently, the reinforcing event is produced.

Socially mediated access often occurs through some form of vocal request, but it need not be so. A celebrity gestures to his driver, who subsequently opens the door to the limousine for him. The gesture functioned in the same manner as a vocal request, “Henri, the door please.”

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A child at a residential facility comes to the dinner table, and staff provide him with his snack for the afternoon. Coming to the dinner table is interpreted as “he is hungry.” In some cases, the vocal request may not even appear to be a request. A client with schizophrenia mutters about people stealing her money. Subsequently, after meeting with the facility administrator, she gets a few dollars to spend on candy and soda in the vending machines. It is important to be cognizant of the role staff, care providers, and adults play in the maintenance of this type of problem behavior.

In the previous case involving a client jumping out of a wheelchair, other behaviors might also produce the same function through mediation of the behavior from staff. Instead of jumping out of the wheelchair, let us say the client learned to have toileting accidents in order to get out of the wheelchair (i.e., staff have to clean him up, thus taking him out of the wheelchair). One could derive an equivalence between this existing environmental outcome of a toileting accident with a vocal request, “Can I get out of this?’ being honored by getting out of the wheelchair. Note that the outcome is the same for both behaviors; getting out of the wheelchair. If a client is incapable of such a vocal request due to language impairments, then having accidents becomes functional under that scenario. With socially mediated access functions, people play a major role in the development and maintenance of target problem behaviors becoming functional.

Direct Escape (DE) Behavior can also produce the direct termination of existing aversive environmental events, serving a direct escape function (Cipani, 1990, 1994). For example, an individual walks into a noisy room, finds the level of noise aversive, and subsequently walks out. Note that the removal of the aversive stimulus (i.e., the heightened noise level in the room) was terminated through a chain of behaviors ending in leaving the room. Walking out of the room produces direct escape. The behavior directly produced the removal of the aversive event involving the noise level. Closing the blinds when the sun is too bright (for you) directly terminates the aversive stimulus (i.e., bright sun light). Taking a shower involves a chain of behaviors that is highly probable for many of us under conditions of being hot and sweaty (after physical exertion) because it directly terminates that condition (being hot and sweaty). These are all examples of chains of behaviors that produce escape (or avoidance) of aversive stimulation in a direct manner. This function is referred to in the behavior analysis literature as automatic negative reinforcement.

Socially Mediated Escape (SME) Behaviors Escape behaviors can often achieve their effect of removing or avoiding an aversive condition through the behavior of someone else (Cipani, 1995; Iwata, 1987; Iwata, Dorsey, Slifer, Bauman, & Richman, 1982). In the case of the noisy movie theater, an individual verbally protests to the manager of the facility, who then gets the crowd to quiet down. The verbal protest behavior exerted its desired effect through the behavior of another person—the manager. If the individual yells loudly, “Let’s have some quiet in here,” and the room quiets down, the desired result was produced through a vocal request. The result (cessation of noise) was produced through other people becoming quieter as a result of this behavior. Both of these examples involve a behavior that achieves its effect indirectly, through the behavior or actions of someone else. However, if this annoyed person simply leaves the theater, thus terminating the noise, such a behavior produced its effect directly when the chain of behaviors ended in leaving the theater.

Negative reinforcement effects via escape functions can also explain why care providers, parents, and staff respond to their child or client’s behavior in the manner they do. In conducting workshops, I have seen participants begin to realize how much of a role the client’s social environment plays in the rate of problem behavior. Invariably, someone will make the following comment: “Why doesn’t the parent [care providers/staff members, teachers, aides, etc.] see that they are enabling [now you would say maintaining] the child’s misbehaviors?”

1 Basic Concepts and Principles 13

Before ascribing a dim view of such people, realize that maintaining contingencies also explain the behavior of parents, care providers, and teachers as well! An analysis of a behavioral function is not just for explaining why clients do what they do. Recall the case of the child who cries when put in the time-out room. As delineated previously, crying in this circumstance is probable because it affects the length of time the child stays in the time-out area. When the child cries, getting out early is more likely. When the child does not cry, getting out early is less likely. That is an analysis of the child’s crying behavior in time-out. But what analysis fits the parent who reinforces (mistakenly) that crying behavior by letting the child out?

When the parent removes the child from the time-out, what environmental effect do you think that produces? Does the child exacerbate the crying upon being let out? No, in fact the opposite is true. The child stops (at some point) crying and whining. As you can see, the child’s behavior affects also the parent’s behavior. If you put the child in time-out, then you fill the room or house with crying. If you take the child out of time-out, the crying stops. What function explains the contingency that results in increasing a behavior that terminates an aversive event? Escape function! The parent’s response to the child’s crying is under control of the presence of the aversive event (crying). When the parent’s response results in the child stopping the tantrum, such a parental response becomes more likely in the future. The parent learns to terminate (escape) the aversive state of the child crying by terminating the time-out prematurely.

In fact, the parent can avoid the crying in the first place by not putting the child in time- out when misbehaving. Instead of placing the child in time-out, mild warnings are issued, but not often followed by time-out. Therefore, time-out becomes less frequent even though the parent “knows” that the child should go to time-out for the target behavior. The parent learns to avoid the aversive stimulus by not producing time-out as frequently as needed. Unfortunately, this does not help the long-term effectiveness of time-out in reducing the rate of the child’s target behaviors. This phenomenon explains why follow through on consequences by some personnel and parents is weak and inconsistent. It would be nice if children and clients made it easy for us to administer consequences for behavior, but unfortunately, they do not.

DISCUSSION QUESTION 1A Can you describe a hypothetical example illustrating an escape function for an individual’s self-injurious behavior? What would be the likely result of a self- injury incident? When would such a behavior be likely? What would the scenario look like if the self-injury were maintained by access to preferred items?

Simulaton Exercise: Type of access or escape functions

This simulation is designed to give the students practice with role-playing examples of the four major functions. Start the simulation with access functions.

With another person (role respondent), identify some item as a desired item (e.g., a pen, coffee cup). In each trial, which starts with a cue from you that it has begun, engage in either a behavior that directly accesses the item (goes over and gets it) or a behavior that gets the item via the role respondent (e.g., request, undesirable behav- ior such as whining, vociferous demanding, but leave out any profanity—no lawsuits wanted). Remember the socially mediated behavior need not be vocal; the requirement

14 Functional Behavioral Assessment, Diagnosis, and Treatment

is simply that the role respondent acts on such with the retrieval of the desired item. The class then writes down which access function the scenario portrayed. Repeat several times to obtain practice effect.

The same can be done for escape functions except the aversive stimulus is pre- sented (e.g., role respondent can grab your arm/hand, begin talking to himself or herself, stand close to you, present you with an assumed difficult academic task; just make sure such behavior does not create a “real” aversive event to the person—no lawsuits wanted). You then engage in a behavior that directly terminates such an event (leaving the area would be the most typical) or a socially mediated behavior such as vocal protest, intimidating looks to the role respondent, crying, and so on. The class then writes down which access function the scenario portrayed. Repeat several times to obtain practice effect.

WHAT MAKES A REINFORCER A REINFORCER? The prior material delineated the characteristics of four different types of functions. All four functions have a relationship between operant behavior and a specific reinforcement effect it produces. But what makes some activity or event function as a positive reinforcer at a particular time? Or what makes the termination of some event of value at a given time? It is clear that what can function as a reinforcer for one person may not function as a reinforcer for another person. For the hypothetical client Milton, who pinches to get staff to take him for a walk, the walk would be termed the reinforcer. Is getting a walk a reinforcer for all inpatient clients with schizophrenia? Obviously not—“different strokes for different folks” applies here. But is a walk always a desired event for this hypothetical client? Again, obviously not. A walk becomes a desired event for Milton (i.e., reinforcer) when he has not had one for a while. Milton may want a walk around 9 a.m., but after having a walk, he does not want one for another 5 or 6 hours. Hence, pinching will cease for a period of time until getting a walk becomes more of a desire on the part of this client. Pinching as a means to get a walk becomes likely only under the conditions where Milton desires a walk.

Realize that the longer the time since Milton’s last walk, the greater the value of a walk. In layman’s terms, he greatly desires a walk. In day-to-day communication this explanation is not a problem. However, when we attempt to engage in a scientific examination and explanation of how Milton comes to “want” or “desire” a walk, we need a more precise terminology that allows us to analyze the environmental factors that lead a person to “want” a particular item or event. One cannot measure “desire” directly, other than through a very poor proxy such as self-report rating measures. But one can measure in a very quantifiable and reliable manner the amount of time that has passed since the last walk.

When Milton wants or desires a walk, it exists in the absence of that event, that is, he is not currently getting a walk. Also at that instance, there has been some quantifiable length of time where he has not had a walk. A state of deprivation with respect to getting a walk thereby exists. If this state of deprivation is sufficient enough to “motivate” him to engage in behavior that has historically produced a walk, such a deprivation condition or state creates or “establishes” the value of the walk. In other words any given behavioral function becomes operable only when an antecedent condition is in effect that establishes a given event as valuable, that is, a functional reinforcer. The term, Establishing Operation or EO, was first coined by Keller and Schoenfeld (1950) and refers to both states of deprivation (which involve access functions) as well states of aversion (which involve escape functions).2

All access and escape functions exist in the presence of an antecedent condition. There are two variables that are inherent in antecedent conditions: motivational and discriminative variables. It is important to consider at this point the role of a motivational condition (i.e., in common parlance, people’s motivation for doing what they do). It is the “driving force” (Cipani & Schock, 2011; Cipani & Cipani 2017) of a behavioral function. Milton engages in behavior that produces a walk at that particular time because the prevailing motivational

1 Basic Concepts and Principles 15

condition (EO) is sufficient enough to create two effects: (a) establish getting a walk as being of extreme value and (b) make behaviors that have historically been effective in obtaining such an outcome very probable. This is true for everyone. The motivational condition or EO “drives” the function. When the EO is considerable at a given point in time, a function becomes operable, and a historically effective “functional” behavior occurs and thereby produces the desired outcome (getting something or getting away from something). When the EO is weak or nonexistent, a particular function does not exist. Hence any behavior that produces a specific given outcome is not probable. For example, if getting attention becomes valuable (i.e., EO for attention is great), then a behavior that produces attention becomes very probable. When the EO for someone’s attention is weak to nonexistent, such a behavior becomes less likely (unless it also serves other functions).

For example, students raise their hands when they want teacher attention and help with an ambiguous part of a class assignment. The EO for attention/help is of sufficient strength to make such a behavior likely, because the value of teacher help has been made essential. Once the student gets the necessary help/instructions, the “need” to raise one’s hand diminishes for a while (until the assignment once again becomes ambiguous to this student). In the current terminology, the EO has been lessened and abated. In summary, the greater the strength of the EO the greater the likelihood the person will engage in a behavior that effectively produces the particular outcome. The lower the strength of the EO the lower the likelihood the person will engage in such a functional behavior. EOs drive particular relevant functions!

But why do some people desire potato chips twice a day whereas other people can go a week without such a desire (interpret “desire” for EO)? Based on current research, all EOs appear to be unique to the individual person. Each person will differ with regard to the specific level of deprivation or aversion that establishes the value of a particular outcome (be it access or escape function).

Consider the question: What is the point at which food will operate as an effective reinforcer (i.e., food deprivation, increased calorie expenditure)? For some people it is 4 hours after they finished eating lunch. For other people, the point at which food will operate as an effective reinforcer does not occur until the end of the day. One cannot say food will operate as an effective reinforcer when we deny access to food for a 10-hour period (absolute value), nor can one say that it will be a static time period for that individual without considering the level of calorie expenditure for that person. Food deprivation is relative to the individual under consideration and dependent on level of activity. It is also relative to other states of deprivation or aversion that may exist at that time.

Therefore, the point in time when a given individual will engage in behaviors that make access to food highly likely is different for each individual and each situation. However, the extent of the deprivation state necessary for food to become valuable, for a particular person, is quantifiable and can be determined with a high degree of accuracy using one of the various analogue assessment procedures (see Chapter 2).

DISCUSSION QUESTION 1B “Absence makes the heart grow fonder!” Can you explain this in behavioral terms (EO) and use a hypothetical example to illustrate your point?

EOs for Access Functions EOs relative to access functions typically involve some period of deprivation of that item or event (i.e., deprivation EO). To reiterate, the amount of deprivation necessary to produce an establishing operation is relative to each individual, and not one absolute value for everyone. Table 1.4 presents several examples of EOs for access functions and the more informal, layman’s term used to describe these events in general conversation. In the first example, a person may have eaten breakfast but missed lunch, so by the time dinner is being prepared, the value of food is very high. Therefore, any behavior or set of behaviors that result in obtaining

16 Functional Behavioral Assessment, Diagnosis, and Treatment

food will be strengthened. The value of food will be abolished when some volume of food has been ingested causing the stomach to expand. In the second example, if a person has not had any fluids for several hours, the value of fluids will be established. Any behaviors that result in obtaining fluids will be strengthened. In this case, ingesting fluids will operate as an abolishing operation.

In the third example, consider that bartenders have long understood how to effectively establish the value of fluid intake. Have you ever been to a bar at happy hour? There are typically many food items available for free. Have you also noticed that when you eat the free food, you seem to get thirsty much more quickly than usual? Most of the food items served at happy hour are either high in salt content or very spicy. This, of course, tends to establish the value of fluids, and the discriminative stimulus (SD) for availability of fluids is typically the bartender. The fourth example considers that for most people not having physical contact (or a specific type of physical contact) for an extended period of time will establish the value of physical interaction. Under this condition any behavior that results in some level of physical interaction will be strengthened. It appears that there is an EO for some level of physical contact.

Having no social interactions for a specific period of time will increase the value of any interaction (see fifth example). In regard to attention, the EO may be for a specific person, which means the reinforcer would be attention from the specific person. In the sixth example we consider the case of a child with a history of watching TV every day after school. The television stops working, so the child does not have access to TV after school for a period of about 1 week. The value of TV watching will increase such that, given the opportunity, he will engage in high levels of behavior to get access to viewing TV.

Example seven presents that some level of stimulation appears to be an EO. Deprivation of all types of stimulation for some period of time will increase the value of any type of stimulation. Consider the case of an individual with restricted mobility living in an environment that is deprived of stimulation. Under this condition, individuals will frequently engage in “mouthing” of clothing, hands, or any item they can manipulate. These behaviors produce some level of stimulation, and therefore, under this condition the mouthing behaviors will be strengthened.

The eighth example illustrates that people who smoke certainly value cigarettes, and we can clearly establish the value of a cigarette by ensuring the person does not smoke for some period of time (EO). Under this condition, any behavior that produces access to cigarette smoke will be strengthened. The abolishing operation in this case appears to be levels of nicotine in the person’s body.

TABLE 1.4 n ESTABLISHING OPERATIONS FOR ACCESS FUNCTIONS

Establishing Operation Lay Term Reinforcer for Some Behavior

1. Deprived of food Hungry Food

2. Deprived of drink Thirsty Drink, liquids

3. Ingested salt Thirsty Drink, liquids

4. Deprived of physical contact Wants hugs Physical contact (specific type)

5. Deprived of attention Annoying, wants attention Attention (specific person/ type)

6. Deprived of TV Wants TV TV

7. Deprived of stimulation, all varieties

Wants stimulation Stimulation (specific kind)

8. Smoker deprived of cigarettes

Wants to smoke Inhalation of cigarette smoke

1 Basic Concepts and Principles 17

In some cases there may be a considerable delay between the EO and the actual occurrence of any behavior related to that specific EO. Here is a perfect example. Some clients in treatment facilities will retaliate against a peer who has assaulted them. This is easily explained when the retaliation is immediate, but how do you explain retaliation that occurs several days later? Clearly the EO establishing the value of retaliation to the other person is already at maximal value immediately after the person is assaulted. What would account for the delay? The most likely explanation is related to the availability of retaliation (inflicting damage to the other person) as a reinforcing event. Specifically, after an assault event, staff are more likely to be vigilant in order to avoid the retaliation. They are more likely to be present when the two clients are in the same area. Staff presence makes the context for retaliation not available, because the staff would prevent the occurrence of damage to the other client. Over time the staff are less vigilant, and eventually the two clients are left alone. Under this condition, assault is highly likely to produce damage to the other client because the staff are unlikely to be close enough to intervene, so the retaliation then occurs. Because this may occur several weeks after the initial assault event, staff may report that it happened for no reason or “out of the blue.”

DISCUSSION QUESTION 1C Explain what a deprivation establishing operation is. How does it affect the value of the specific reinforcer? Give an example of the EO and its effect on a function involving attention.

EOs for Escape Functions Thus far we have considered EOs only for access functions. EOs for escape functions have the same characteristics as those for access functions. However, the environmental event in this case is related to an outcome that the individual is acting to avoid or terminate (see Table 1.5). The establishing operation consists of a state of aversion, hence an aversive EO.

In the first example, a teacher may present a relatively difficult task to the child. Because the child is not capable of performing such a task or demand, he or she finds the presence of such a task demand aversive (EO). Therefore, a behavior, or set of behaviors, in the repertoire of this child that results in its removal will be strengthened. Realize that what is difficult for one child may be easy for another, hence, difficult task is a relative term.

In example two, a behavior that terminates the presence of a person’s obnoxious behavior will be strengthened under conditions involving the presence of the noxious conditions (EO). Let us say this person’s obnoxious behavior is using foul language. If a person does something that affects this person whereby such language is lessened or eliminated, such behavior will be strengthened in the future when faced with this person’s foul language. But let us say that nothing seems to perturb this individual who goes right on with rude language. Leaving the area then becomes probable. Why? Because it terminates the person having to listen to and put up with such language. In example three, painful stimulation establishes the value of termination of the discomfort (EO). Behaviors that produce escape or avoidance of such painful stimulation will be strengthened. Again, painful is a relative phenomenon, varying according to the individual.

In example four we consider that for many people, rain on the head establishes the value of terminating rain on the head (EO). This group of people will therefore engage in behavior that results in rain no longer falling on their heads. This may include using an umbrella, holding something else over their heads, or simply going under cover. Any of these behaviors have the same effect of stopping rain on the head and will therefore be strengthened. Example five is similar to example one; however, in this case, the teacher may present a relatively long task to the child. Because the child is not capable of performing such a task or demand for that long period of time, the task demand is aversive (EO). Therefore, a behavior, or set of behaviors, in the repertoire of this child that results in its removal will be strengthened.

18 Functional Behavioral Assessment, Diagnosis, and Treatment

Example six considers the behavioral effects of EPS, which are side effects associated with many antipsychotic medications. These EPS can be quite aversive. The occurrence of EPS will establish the value of (EO) terminating the EPS. The most direct means to terminate the EPS is to stop taking the medications that cause the EPS. This EO is frequently the major factor in medication noncompliance for people diagnosed with major mental illness. In example seven we consider that for people who have allergies and experience the private event of a sinus headache, the value of terminating that stimulus is established (EO) when they are in the midst of a sinus headache. Most have found multiple means to do this: (a) take sinus medication; (b) take a hot, steamy shower; and (c) apply ice packs to the affected area. But suppose you are living in an institution, and you are not verbal and therefore unable to communicate that you have a sinus headache. The most direct way to terminate the sinus pain, albeit briefly, is to press on or hit the sinus area that is producing the pain, thus these behaviors would be strengthened.

Examples eight and nine review how the occurrence of drug or alcohol withdrawal symptoms will establish the value of terminating the withdrawal symptoms (EO). The most direct means to terminate the withdrawal symptoms is to take the drug associated with the withdrawal symptoms, thus strengthening this behavior. The first use of drugs and long-term abstinence is associated with several other EOs. The particular EOs involved are typically idiosyncratic but can and should be delineated when approaching the treatment of substance abuse.

Consider some people with the genetic syndrome called Prader-Willi. They never seem to ingest enough food or calories to abolish food as a reinforcer. For these individuals, the value of food is established anytime they are not ingesting food. For people diagnosed with borderline personality disorder, the value of adult or peer attention is difficult to diminish or abolish, and the value of attention is established very quickly after the last social interaction. Both of these examples are probably best analyzed as difficulties associated with ineffective AOs. In both cases you could reduce the value of the reinforcer (food, attention) by continuous, noncontingent reinforcement, but in both cases this presents pragmatic and ethical concerns.

TABLE 1.5 n ESTABLISHING OPERATIONS FOR ESCAPE FUNCTIONS

Establishing Operation Lay Term Reinforcer for Some Behavior

1. Presence of difficult task Lazy Removal of task

2. Person acting in an obnoxious manner

Annoyed Terminating engagement in social situation

3. Presence of pain In pain Termination of painful stimulus

4. Rain on the head Does not want to get wet Termination of rain on head

5. Request to complete a long task

Unmotivated Shortening or termination of the long task

6. Occurrence of extra pyramidal symptoms (EPS)

Wants symptoms to stop Termination of the EPS

7. Allergic rhinitis Wants relief from allergies Termination or reduction in allergy symptoms

8. Drug withdrawal symptoms Wants more drugs Termination or reduction of withdrawal symptoms

9. Alcohol withdrawal symptoms

Wants more alcohol Termination or reduction of withdrawal symptoms

EPS, extra pyramidal symptoms.

1 Basic Concepts and Principles 19

Abolishing Operations As mentioned earlier, once the functional reinforcer is delivered for a given behavior, the value of such an event is diminished. The delivery of a sufficient amount of the reinforcer abolishes the existing EO. Hence, this operation is termed the AO. Table 1.6 depicts access functions and the relationship between EOs, behavior, and AOs, using the prior examples found in Table 1.4. In example 1, the delivery of a sufficient amount of food results in the abolishment of the prior state of deprivation. In plain English, once you have eaten enough (relative to each individual), you are no longer hungry. The remaining examples illustrate the same principle of the AO relative to the initial deprivation EO. It is important to note in each example that the AO exists once there is a sufficient amount of the functional reinforcer acquired.

The same is also true for escape functions, with respect to the EO, behavior, reinforcer delivery, and the AO. Table 1.7 illustrates their relationship. In example 1, the removal of the task for some behavior produces the AO—termination of the aversive EO.

DISCUSSION QUESTION 1D Explain what an aversive establishing operation is. Using an aversive interaction with a classmate as the presenting condition, give an example of an escape function, by delineating a behavior and its effect.

TABLE 1.6 n RELATIONSHIP BETWEEN ESTABLISHING OPERATION, BEHAVIOR, DELIVERY OF REINFORCER, AND ABOLISHING OPERATION FOR ACCESS FUNCTIONS

Establishing Operation

Lay Term Reinforcer for Some Behavior

Abolishing Operation

1. Deprived of food Hungry Food Intake of sufficient volume of food (Expansion of stomach)

2. Deprived of drink Thirsty Drink, liquids Intake of sufficient volume of fluids

3. Ingested salt Thirsty Drink, liquids Intake of sufficient volume of fluids

4. Deprived of physical contact

Wants hugs Physical contact (specific type)

Sufficient duration of physical contact

5. Deprived of attention

Annoying, wants attention

Attention (specific person/type)

Sufficient duration of attention

6. Deprived of TV Wants TV TV Sufficient duration of TV

7. Deprived of stimulation, all varieties

Wants stimulation Stimulation (specific kind)

Sufficient duration of stimulation

8. Smoker deprived of cigarettes

Wants to smoke Inhalation of cigarette smoke

Sufficient level of nicotine in system

20 Functional Behavioral Assessment, Diagnosis, and Treatment

Antecedent Discriminative Stimuli You should now understand the role of motivation: behaviorally defined as the existence of an establishing operation (motivational condition is great) or an abolishing operation (motivational condition is lessened or not existent), and its effect on the function of behavior. However, you may be asking the following question: “Why does a child with severe disabilities hit him or herself when in the classroom to get a cookie (EO present); but points to a picture of the cookie to get one when with the speech therapist?” The answer: People reinforce (sometimes inadvertently) specific behaviors under specified motivational conditions!

Socially Mediated Functions and Discriminative Stimuli. The technical term for the other antecedent variable that affects behavior is the “discriminative stimulus” (SD). The SD is a stimulus associated with the availability of an outcome (given a specific behavior or class of behaviors). While you may be familiar with this term as it relates to instructions, directives, and task demands, let us examine its role in socially mediated functions of problem behavior, where the reinforcer is produced via the behavior of another person. This is important to

TABLE 1.7 n RELATIONSHIP BETWEEN ESTABLISHING OPERATION, BEHAVIOR, DELIVERY OF REINFORCER, AND ABOLISHING OPERATION FOR ESACPE FUNCTIONS

Establishing Operation

Lay Term Reinforcer for Some Behavior

Abolishing Operation

1. Presence of difficult task

Lazy Removal of task Removal or delay of task or removal of that portion of the task that is difficult

2. Person acting in an obnoxious manner

Annoyed Terminating engagement in social situation

Removal or avoidance of specific person or type of interaction

3. Presence of pain In pain Termination of painful stimulus

Reduction or avoidance of pain stimulus

4. Rain on the head Does not want to get wet

Termination of rain on head

Removal or avoidance of rain on head

5. Request to complete a long task

Unmotivated Shortening or termination of the long task

Removal or avoidance of the request or reduction in the length of the task

6. Occurrence of EPS Wants symptoms to stop

Termination of the EPS

Removal, reduction, or avoidance of the symptoms

7. Allergic rhinitis Wants relief from allergies

Termination or reduction in allergy symptoms

Removal, reduction, or avoidance of the symptoms

8. Drug withdrawal symptoms

Wants more drugs Termination or reduction of withdrawal symptoms

Removal, reduction, or avoidance of the symptoms

9. Alcohol withdrawal symptoms

Wants more alcohol Termination or reduction of withdrawal symptoms

Removal, reduction, or avoidance of the symptoms

EPS, extra pyramidal symptoms.

1 Basic Concepts and Principles 21

remember as we examine what part the discriminative stimulus plays in socially mediated functions and what or who represents the SD.

The previous example illustrates that the same desired outcome is obtained with two different behaviors, hitting oneself versus pointing to a picture. Why does the client hit him- or herself in the classroom? Someone has made cookies accessible for that particular behavior a reliable outcome! Why does the person not hit self in the speech therapy room? The speech therapist has not made hitting a behavior that produces cookies; rather a nonvocal communication produces that result. Both the person in the classroom and the therapist “are correlated with” the availability of cookies—but what behavior “works” is quite in contrast. In one circumstance, hitting is the functional behavior; in the other, pointing to a picture is functional. Therefore, the person in the classroom is discriminative for hitting oneself to obtain cookies. This is not the case with the speech therapist. The speech therapist is discriminative for communication responses to obtain cookies.

For socially mediated functions, people constitute the discriminative stimulus (at least part of it). Since the reinforcer is obtained via their actions, people determine what behaviors result in obtaining such. This is true for not just attention and tangible reinforcers, but also for the termination of aversive events. The previous example could just as easily portray a circumstance where the child hits him- or herself to have the classroom instructional staff person terminate a task demand. Such staff persons would be discriminative for escape behaviors involving self-abuse. In their presence, self-abuse results in the task being removed. The speech therapist ends the session when the child points to a picture with the words printed underneath, “break, please.” She would be discriminative for such a behavior serving as the mechanism for escape from the session. In short, a specific function under a given EO is operable with a particular person(s) serving as the discriminative stimulus.

How do you determine what person(s) is discriminative for problem behavior? In the previous example, when the child is desiring a cookie, and is with the teacher, what are you very likely to see? Problem behavior! Hence, it is often easy to determine the discriminative stimulus for socially mediated functions. Persons in the child’s natural environment where the rate of problem target behavior is high are discriminative for such behaviors.

For those of you who use profane language at times, you might reflect on the circumstances where such behavior is more probable. Where you do engage in such language, people and contexts serve as discriminative stimuli for such language. In contrast, being in church or at your professional job involves stimuli that make such language unlikely (hopefully).

Can a person be discriminative for problem behaviors in one setting, but not serve as a discriminative stimulus for such behavior in a different setting? Of course! You probably can recall many circumstances where someone behaves differently in two different contexts, with the same person involved in the provision of the desired reinforcer. For example, a child may engage in mild crying (“whining”) to get a cookie at the grocery store from his or her mother. However, such behavior at home results in being sent to one’s room (without cookie). Even with the same adult, the function of one set of behaviors can be operable in one setting, and yet be nonfunctional in another setting.

DISCUSSION QUESTION 1E Provide a scenario contrasting how an adolescent girl can behave in one fashion to get attention from her parent and then engage in a different behavior to get attention from her boyfriend. Identify the discriminative stimulus for each situation.

Direct Contingency Functions and Discriminative Stimuli. For problem behaviors that serve a direct contingency function under deprivation or aversive EOs (DA or DE functions), people do not constitute the discriminative stimulus condition! What are the characteristics of discriminative stimuli for DA and DE functions? First, there is some context condition in the physical environment that makes the desired outcome available. But this also is often combined with the absence of certain people that would impede the direct

22 Functional Behavioral Assessment, Diagnosis, and Treatment

access or escape. These two conditions usually sets the stage for an unacceptable behavior that directly produces the desired outcome unencumbered.

If a client wanted an extra piece of cake in the refrigerator, and was not allowed to have such, what are the conditions under which the behavior of grabbing a piece would be effective? Obviously, the refrigerator has to have a piece of cake in it (physical discriminative stimulus present). But also, the staff person or persons who would impede such an effort would have to be away, or maybe “sleeping on the job.”3 For problem behaviors that directly access the tangible reinforcer, when such is not allowed or prohibited, the absence of persons who would interfere with the obtaining of such is discriminative for such attempts, along with the availability of the desired item in the physical environment.

Suppose someone wanted to leave the classroom. The door serves as the discriminative stimulus in the physical environment that makes the chain of behaviors that lead to opening it and walking outside functional. Unless some staff person is blocking the door! The chain of behaviors that would lead to outside will be successful only if the staff person is either not there, or is engaged in a distracting activity, which makes the “escape” viable.

In summary, there are two parts to the antecedent condition for a given function. The EO is the “driving force” for the function, establishing the value of getting something or getting away from something. The discriminative stimulus dictates the manner (i.e., form of behavior) in which the desired outcome will be procured. With those two elements, a specific behavioral function exists.

CHANGING BEHAVIOR BY ALTERING THE EO When considering behavior change at the antecedent level, it is important to be aware that the greater the value of the EO, the greater the strength of the behavior. A person deprived of food for 24 hours will be much more likely to engage in behavior that has historically been effective in procuring food than a person who has just finished eating a full meal. As the value of the EO increases, the frequency (both absolute and relative), duration, and intensity of behaviors associated with abolishing that EO will also increase.

For example, let us say that you have been without a candy bar for 1 day. Given this level of candy bar absence, the EO is not sufficient for you to go out of your way to go buy one. Of course, if one happens to be in a desk drawer of yours, given that state of deprivation you would eat it. But to reiterate, you would not expend a great amount of effort to get a candy bar at this point. However, let us say a week goes by and you (for some reason) have not yet had a candy bar. Additionally, you see someone at work who has just opened one and starts eating it. At this point the state of deprivation is great, and with the added observation of someone else eating one, you scour the neighborhood at work to find a candy bar. In fact, you do not give up your quest to get the candy bar until you finally locate one with about just 10 minutes to go before you must get back to work. Your “desire” (i.e., EO) was so great you were willing to forego some other usual lunchtime activities (e.g., sitting by the nearby lake and “people watching”) to obtain a candy bar! The state of deprivation with respect to any item (or state of aversion as well) does vary across time. When it reaches a point where such is sufficiently deprived (relative to that person and other states of deprivation and aversion prevailing at that time), functional behaviors become more probable, intense, and frequent. Until the AO results!

Decreasing Targeted Behaviors by Reducing the EO Strength Would you engage in a behavior (of some considerable effort) that obtains something if you have had “your fill” of that item? Let us say a young man with physical disabilities has learned to scream to get some school staff person to come to him and move his wheelchair outside, under a deprivation EO for such. Of course this is not a desirable circumstance, and some intervention is needed. Suppose when examining his screaming bouts for the past several weeks, we note that he screams between two and four times per day. Remember that his screaming occurs under a desire to be wheeled outside the classroom at that point in time. What do you think would happen to the frequency of his screaming bouts if school personnel took him outside about once an hour (i.e., five or six times per school day)? It makes

1 Basic Concepts and Principles 23

screaming rather useless, that is, nonfunctional. By making outside time more available to him, we reduce the possibility of a deprivation EO occurring with respect to outside time. Hence it is unlikely that this student will be faced with a time when he desires being outside, since the amount of outside time programmed into his schedule is at or above his usual level (2–4 times). He will not find the “need” to scream.

For example, if a child engages in a behavior to get a certain preferred activity, such as computer time, then increasing the child’s time on the computer two- or three-fold over the current access level will do two things. First, such a manipulation will reduce the value of this particular event. Second, it will alter the frequency of the target behavior that serves such function, that is, getting computer time.

In regard to behaviors serving escape functions, there are two methods for making escape from some aversive condition not as necessary (i.e., valuable). These methods are: (a) do not present the aversive EO or (b) alter one of the elements that make such a condition aversive. Here is an example of the first method. A hypothetical student does “not like” long division (such constitutes an aversive EO), and engages in a variety of disruptive behaviors when asked to do such by the teacher. Of course, such behaviors are relatively successful in getting the teacher to terminate such a task and provide an alternate task. Given that information, what would you predict would be the outcome if, one day, the teacher did not present the long division problems but instead started with the task that the teacher would otherwise switch to when encountering disruptive behavior? By not presenting the aversive EO, the teacher would also avoid the disruptive behavior the student typically exhibits.

In summation, one can decrease, if not eliminate, the behavior associated with a particular EO by ensuring that it never becomes valuable. In the case of access functions, this involves providing the reinforcer frequently and at high enough levels such that their value is never established. While this antecedent manipulation does not alter the function of the target behavior directly, it will reduce the behavior in frequency, duration, and intensity, as well as increasing response latency. Table 1.6 provides some examples of this methodology. With regard to target behaviors maintained by escape functions, the method of changing the motivational condition for such behaviors is to eliminate the presence of the aversive event, make it less aversive, or terminate the aversive condition noncontingently (see Table 1.7).

It may also be possible to alter slightly the presenting conditions, removing just the factor(s) that make the condition aversive. Of course, one would have to be quite familiar with the student or client to utilize such a strategy. In the previous example, let us assume that long division is aversive to this student because he or she is not skilled at the procedures of doing such. We observe the student’s struggles with how to divide the divisor into the relevant part of the dividend. One can make this particular instructional task less aversive by teaching the student how to perform the first step or component of long division (dividing a single digit into the first one or two digits of the dividend), and practice that only (until mastery). Such a strategy reduces the aversive aspect of the task and would thereby reduce the problem behavior. Such a manipulation will ensure that the value of escape or avoidance of that task is never established; as a result, the frequency and intensity of the oppositional behavior will be reduced or eliminated (Tables 1.8 and 1.9).

TABLE 1.8 n ANTECEDENT MANIPULATIONS FOR ACCESS FUNCTIONS

Maintaining Reinforcer Antecedent Manipulation

Adult attention Increase frequency/duration of attention

Tangible reinforcer (food) Increase availability of food throughout the day/time period

Tangible reinforcer (free time) Increase availability of free time throughout the day/time period

Tangible reinforcer (preferred activity) Increase availability of preferred activity throughout the day/time period

24 Functional Behavioral Assessment, Diagnosis, and Treatment

Increasing Behavior by Enhancing the EO Strength As should be clear to you by now, a behavior (that produces a given function) is unlikely to occur if the value of a particular outcome has not been established. When attempting to teach a new behavior, it is important to understand that there are two ways to ensure that a reinforcer is at its maximal value. First, you could wait for naturally occurring environmental changes that establish the value of a particular outcome. For example, if you are trying to work on establishing behaviors related to accessing food, you could wait until right before meal times to use food as a reinforcer. Second, you could contrive a situation that increases the value of some outcome as a reinforcer. For example, if you are trying to work on establishing behaviors related to accessing fluids, you could provide very salty food to a person prior to and during training, thereby ensuring that the value of fluids remains at a relatively high level.

A more frequent use of contrived EOs is seen in the teaching of social skills and verbal behavior. You can manipulate the value of social/verbal interactions by establishing the value of a tangible reinforcer and then making access to that reinforcer dependent on a social interaction. This arrangement will establish the value of social interaction. Once the value of social or verbal interaction is established, you can effectively invoke the social behavior.

CONTRIVED CONTINGENCIES PRODUCE A FUNCTION Reinforcement systems that are designed to simply target appropriate behavior for increase have been referred to as contrived contingencies. The derivation of the specific contingency is contrived in that the functional relationship between problem behavior and its enabling contingency may not have been utilized or deduced. In using contrived contingencies to solve problems, one simply selects a powerful reinforcer, of unknown relationship to the current problem behavior, and delineates a temporal relationship between it and some desirable behavior. Such a contrived contingency hopefully competes with the existing function of the problem behavior.

Nevertheless, contrived contingencies do produce a function, and there are many reasons why they may be preferred as a first stage of an ecological intervention in many settings. A  contrived classroom contingency arranges a functional relationship between some target criterion behavior (e.g., a designated percentage of time on-task, designated score on quiz grades) and production of effective reinforcers (Barrish, Saunders, & Wolf, 1969; Greenwood, Hops, Delquadri, & Guild, 1974). Point or token systems entail conditioned reinforcers (points) that are traded in for back-up reinforcers. The designation of potent back-up reinforcers provides the system with the requisite mechanism to influence behavior

TABLE 1.9 n ANTECEDENT MANIPULATIONS FOR ESCAPE FUNCTIONS

Maintaining Negative Reinforcer Antecedent Manipulation

Removal of unpleasant social situation

Avoid presenting such events, or reduce the level of aversion by altering some aspect of the situation

Removal of relatively lengthy task, chore, or assignment

Avoid presenting such tasks, chores, or assignments, or reduce the level of aversion by altering the length of the task

Removal of relatively difficult task, chore, or assignment

Avoid presenting such tasks, chores, or assignments, or reduce the level of aversion by altering the difficulty of the task

Removal of physically aversive stimulus

Avoid presenting such aversive stimuli, or reduce the level of aversion by altering some critical aspect of the stimulus

1 Basic Concepts and Principles 25

(Inkster  & McLaughlin, 1993). Therefore, such contrived contingencies make student performance on the assignment or material of consequence. Many people refer to contrived contingencies as nonfunctional contingencies. You should now realize that functional is determined by the environment, given the presence of certain EOs. Designating a contrived contingency makes some behaviors functional with respect to the delivery of certain stimuli that are hopefully precious at that moment in time. Let us examine how contrived contingencies produce functions.

Ms. Tally designs a point system that provides points for on-task behavior during intermittent observations of such behavior. She has learned in her behavior analysis courses that contrived reinforcement contingencies have been demonstrated to be effective with many students, including those labeled as unmotivated and not intrinsically motivated. She feels that the term intrinsically motivated describes a certain percentage of students in her classroom, and she wants them to perform to a higher level. She implements a beeper system to increase student on-task behavior (see Cipani, 2008, for details). On-task behavior is often defined as looking at the materials during seat assignments or at the teacher during lesson presentations or instructions. A beep is produced at random intervals. With these random beeps, she intermittently observes the students in her class and records whether they are engaged with their class assignment. When students are demonstrating on-task at the time of the sampling, they earn points. If they are not on-task at that point in time, they do not earn points. Points are traded in later for a variety of back-up reinforcers, such as tangible items and preferred activities.

Ms. Tally implements this program for 4 weeks subsequent to a baseline. As a result of implementing the beeper system, the mean rate of on-task behavior goes from 46% during baseline to 77% for the first 4 weeks of treatment. Further evidence of the efficacy of the beeper system is the substantial improvement on the students’ quiz grades. Why does this procedural arrangement between student engagement and contrived reinforcement contingencies work? In using the beeper system, it was not necessary for Ms. Tally to determine the function of the existing off-task behaviors in order to reduce the level. Why does such a contingent relationship alter student performance in the desirable direction?

The environment often creates, through the class routine involving instructional periods and associated academic tasks, deprivation with respect to student-preferred items or activities. The extent to which the contrived contingencies involving points will increase the rate or level of on-task behavior (or other targeted behavior) depends on two factors: (a) the relative deprivation of the back-up items and (b) the aversive nature of the current tasks or activities. When the back-up items and events are relatively deprived, behaviors that produce such become more probable. In using the beeper system, on-task behavior becomes functional in producing points that provide eventual access to such events. Hence a function exists. If this new function “overpowers” the aversive EO or EOs of the particular task, it will make on-task behaviors very likely with this particular teacher and her imposition of the point system.

Therefore, contrived contingencies may address EOs that are far more powerful in terms of their value-altering effects than the EO for the current problem behavior. For example, a student engages in gazing out the window for minutes at a time to take in the view. We could hypothesize that such behavior may either be a function of direct access to visual sensory reinforcement or direct escape of engagement with instructional materials. In the absence of contrived reinforcers for performance, such behavior occurs several times (of variable duration) in a given instructional period. The teacher may even report that this student gets easily distracted. However, when contrived contingencies for on-task behavior are deployed, via the beeper system, gazing out the window goes down to a markedly lower frequency and also of very short duration. Note that the EO addressed by the contrived contingency overrides the weaker motivating condition for viewing the scenery or directly escaping the task. Looking outside the window does not produce a reinforcer that is as powerful as getting points for back-up tangible reinforcers such as extra free time. As the movie adage taken from Jerry McGuire goes, “Show me the money!”

What about the students who do not need teacher-designed contrived contingencies to persist in engaging in the task or assignment? Some students (often labeled as “good”) continue to perform despite getting more work after they complete their initial assignment.

26 Functional Behavioral Assessment, Diagnosis, and Treatment

Are these instances of intrinsic reinforcement? While many nonbehavioral educators point to this as an example of intrinsic motivation, they fail to understand the powerful role of other superimposed contingencies on classroom performance. Performing well in class can bring teacher, parent, or other adult attention and, in some cases, peer approval and attention. Grades also provide a source of social contingencies, and some additional benefits from rule-specifying contingencies (“If I get good grades, I’ll go to college.”). Therefore, in these students, because other EOs are present (e.g., attention from teacher, parents, peers), and there are discriminative stimuli for such behavior, their behavior is well understood within a contingency analysis. These students’ performances are sustained because of these inherent superimposed contingencies in a given student’s life.

While such superimposed additional contingencies can explain why some competent students do not need contrived contingencies to maintain classroom performance, what about those who do not perform under such conditions? These students cannot perform at the academic levels that recruit such reinforcers. What happens to learners who do not have the competence to be affected by such superimposed contingencies? Very often, the failure to use contrived contingencies with these students results in a decrement in everyday performance. Their performance in the classroom becomes highly variable. On some days, they perform at admirable levels, and on other days they do not complete their assignments. Unfortunately, when their performance over time fails to recruit superimposed additional reinforcement contingencies, such as good grades and adult approval, they become even more unproductive. When these learners fail to consistently recruit those contingencies, their daily work does not come under control of such consequences.

As a result of this failure to recruit superimposed contingencies, classroom instruction and tasks become an aversive condition. Instruction, task assignments, and other learning activities develop aversive stimulus properties, which become EOs for escape and avoidance behaviors. With the reluctance of the teacher to designate some alternate (performance- based) criterion for terminating tasks (see the case of the wacky contingency, Chapter 3), undesirable behaviors become strengthened through the selective reinforcement of such.

SUMMARY Behavior (operant) that occurs with high probability in certain antecedent contexts (EOs and discriminative stimuli) is functional. This is true for both desirable and undesirable behaviors. There are two major functions: (a) access functions (positive reinforcement) and (b) escape functions (negative reinforcement). Further, the manner in which such functions are produced can be from one of two methods: (a) directly or (b) socially mediated. The following chapters will expound on this concept of specific operant behavior becoming functional under specified antecedent contexts as a result of its environmental effect (i.e., delivery of a reinforcer that produces an abolishing operation).

THE CHILD WITHOUT A CONSCIENCE: THE FUNCTION OF BEHAVIOR IN A COMPLEX CASE

When mental health personnel view behavior as a result of an internal condition, behavior is often explained as the result of such a condition. Hence, such behavior is to be expected from time to time, and environmental contexts are relegated to an immaterial role. The following case is instructive for several reasons. First, the type of behaviors occurring at such a young age was rather unusual and of a form that intimidated the adults caring for the child. Second, an analysis of the probable function of such behaviors revealed “super-ordinate” contingencies that existed in foster care placement. Such contingencies are invoked when foster children of a young age engage in behaviors that make the current placement caretakers no longer willing to care for them.

1 Basic Concepts and Principles 27

Description of Case Polly was a 5-year-old child who had been referred to me for in-home behavior management. She was currently residing at her second foster home, having been detained from her biological mother’s home previously by child protective services (CPS). Polly’s biological mother was reported to have perpetrated several incidents involving physically abusive behavior toward Polly and her other siblings. Her first foster placement ended rather quickly (prior to my involvement) as she reportedly exhibited uncontrollable outbursts and tantrums. Subsequently, the foster parent requested a termination of this placement, and the county department of social service turned her case over to a foster family agency (FFA) for placement. The family with whom Polly was residing at the time of my involvement belonged to this FFA. I did not receive much information besides this brief placement history prior to my first home appointment to meet this family. An initial phone contact with the foster mother provided some basic information regarding Polly’s current problems in her home. Polly was described as an out-of-control child who did not respect adult authority. Further, she could become verbally aggressive and sometimes physically destructive when upset.

Background information obtained from the case manager revealed that Polly was initially raised by her biological mother along with four other siblings. Two of the siblings were children of Polly’s mother and father (although Dad had long since disappeared). Her other half-siblings were each fathered by a different man. The mother at the time of detainment was raising all the children on her own.

When Polly attended preschool and childcare, while still in her mother’s custody, she was expelled as a result of severe behavior problems that the school could not tolerate. She was reported by the preschool staff to hit, pinch, bite, and attack other children without provocation. She would not respond to directions from the teachers, particularly directions to go to time-out for misbehaviors. It was during these times that she would become verbally abusive. While staff noted that she could be pleasant and happy on many days, it was her bad days that made the situation intolerable, thus requiring her expulsion.

When Polly was 5 years old, CPS was notified by Polly’s elementary school of possible child endangerment. A CPS social worker came out to investigate that referral and found an abrasion on Polly’s chin. Her brother was found to have a similar mark on his back. The school also reported to CPS that Polly was often 30 minutes early to school without supervision, often dirty, and with no snack. Polly told CPS that there was no food in the house. As a result of all this information, Polly and her younger siblings were detained and placed in foster homes.

On my first appointment I pulled up to the curb of the foster parent’s house and covertly noted that the foster family lived in a nice neighborhood. I was greeted at the door by the foster mother and shown into the living room. Polly was sitting in a chair at the dining room table engaged in some innocuous activity (I thought to myself—“looks good so far”). Present in the room were the foster father, a social worker from the county, and a social worker from the FFA, who would coordinate the behavioral treatment. I began interviewing the foster parents as to the nature of Polly’s behaviors, that is, under what conditions did she seem to exhibit such behaviors and what was their method of attempting to manage her. The parents painted a picture of a child with a dual personality (I am not implying the diagnosis here, their implication, not mine). Sometimes, she was the best-behaved child, played with peers in an appropriate manner, and was so angelic. But on the other hand, when she was upset, watch out. Her demeanor changed, she was no longer pleasant, and profane language and hurtful words poured out of her mouth. However, during the entire time I was interviewing the foster parents and the social workers, I noted no incidence of such behavior. She continued to entertain herself at the table as per the direction of the foster parents.

As I obtained enough information from the foster parents at that time, I then decided to test the waters. If at all possible, I like to see how children handle commands and instructions from me to give me an indication about their compliance to adult instructions. I gave Polly a few brief requests, which were all responded to with a smile. When I praised her and told her she did an excellent job in following my instruction, her smile went from coast to coast. I then

28 Functional Behavioral Assessment, Diagnosis, and Treatment

attempted to correct her on a math task I assigned. This is often a good test of a child’s ability to handle criticism appropriately. This “simulated criticism” can usually evoke some level of agitation with children who are disrespectful of adult instructions. She made no objection or dispute of my correction! Over the course of the 15–20 minutes of individual work with her, in the dining room, while all the adults watched on, she appeared to be the antithesis of the child who was described to me. At that point, I just could not picture what someone would have to do in order for Polly to become a child who was out of control. I could not even envision her being in the vicinity of a screaming tantrum, replete with profanity, let alone being the source of such verbiage.

If first impressions are a valid measure of a child’s behavior in their social environment, one might surmise that Polly’s demonic nature was a figment of the foster parent’s imagination. Could the parents possibly be over- controlling and require perfectionism? How could this innocent child do anything but good! With such great compliance from Polly, the thought of these foster parents being so inept that they could “bungle” parenting such a sweet child ran through my mind but was quickly dismissed. The evidence to the contrary was substantial. In addition to the report from these foster parents, severe behavioral episodes and reactions were reported by Polly’s previous teachers and foster parents.

With no incident of behavior that remotely resembled a troubled child, the foster parents wanted to assure me that this is what they expected for my visit. They indicated that it was Polly’s nature to be angelic with other people. They informed me that she had a mental disorder, which made her act this way in front of strangers, but then she would quickly turn on the parent figure. Could this be the granddaughter of Norman Bates? They handed me some material on reactive attachment disorder (RAD).

Why do these children behave like this? According to attachment theorists (who predominate this field), these children fail to develop attachments because of an early trauma (such as abuse, neglect, or separation). As a result they fail to “bond” with a significant caretaking adult. Because there was no initial bond between the child and mother, they feel no remorse for hurtful incidents regarding other people. According to attachment theorists, a “moral conscience” is developed only as a result of a baby’s attachment to an adult early in life. People who argue this view trivialize the role of social consequences of behavior in teaching children to learn to refrain from saying spiteful things to people. The foster mother reiterated that Polly feels no remorse for persons she hurts or offends. Further, I should not be fooled by the display of good behavior, as these children are the masters at this behavioral deception. She again reassured me that Polly is really disruptive to their family situation, and I should not be fooled by her deceptive appearance on this visit.

Intervention Fortunately, that sermon about RAD did not sway me from my objective: to bring problem behaviors under control of more systematic contingencies. In some cases, treatment merely requires a manipulation of contingencies; in others, skill training is added to that component. The child’s caretakers, whether they be biological parents, foster parents, or group home staff, are then trained on-the-job to perform the requisite behaviors in response to the child’s behavior.

I like to target just one problem area at time, bringing desired change in that area before tackling another. I chose to target a daily context that was generating problems in child management: bedtime. Polly was reported to have difficulty going to bed and staying there. She would get up constantly and have to be put back to bed. To get Polly to accept bedtime more readily, the foster parents had tried enforcing bedtime at a predictable time and incorporating low-key activities prior to bedtime. With that regimen, Polly was having less of a problem at bedtime than in the prior placement. However, on nights when she had difficulty, she had severe tantrums and would get out of the bed constantly.

While these were good first steps on the part of the current caretakers to address bedtime problems, I suggested some additional procedures. There should be an incentive for good

1 Basic Concepts and Principles 29

bedtime behaviors to compete with the desirability of creating havoc in the family household. My plan was to allow Polly to earn a half-hour of later bedtime the following night for good bedtime behavior (the current night). Good bedtime behavior was defined as (a) the lack of tantrum behavior and (b) not getting out of bed once she was placed in bed. She could also lose an hour off of regular bedtime the following night if she got up or had tantrums.

The first two nights of this regimen were not good. The parents estimated that Polly got up about 25 times that first night and a little less the second night. It was fortuitous that the foster parents did not bail out at that point. I had prepared them for this possibility. On the third night, the plan resulted in her complete cooperation and access to the privilege of staying up late the following night. For the entire next week she responded well to the plan, always getting her extra half hour each subsequent night. Parental persistence paid off.

However, these parents gave notice to have her moved prior to my third visit. She was moved to another home about 25 miles away. I was notified initially to discontinue the case because the new foster parent reported that Polly was not a management problem at the time. I noted to myself that a prevention approach was not high on anyone’s list. I was eventually contacted about a month after she was moved, with the presenting problem as arguing behavior (also termed “mouthy behavior,” although the foul language had not yet set in). There were also two reports of major screaming bouts, but the overall impression of the new foster mother was that Polly was manageable and not unlike other foster children she has had.

However, shortly thereafter, and before my first scheduled visit, Polly’s level of tantrums had increased. Of even more significance, her inappropriate language was back in full force. Its form took on a new and ugly twist, one that frightened this foster mother tremendously. She was now threatening to do bodily harm to the foster mother and her toddler grandson, who would come to play at her house (e.g., “I’m going to hurt you” or “I’m going to hit him”). She had not acted on these threats, but I obviously wanted to address this before it reached that stage.

Let us say that the foster mother just told Polly, after a request, that she could not go outside and play (for whatever reason). Polly may not cry like other children. Perhaps her conditioning history taught her that such was not a fruitful approach to getting what you wanted. However, saying, “I hate you, you are a ——— and I am going to ——— you or your baby” was quite the opposite. What would you imagine would happen next? A probable reaction from an adult upon hearing such a threat from a young child is to ask the child why she would want to do that. For example, a parent might say to the child, “Why would you be so mean?” Or, “You don’t mean that, do you?” This would be followed by Polly saying, “Because I hate you,” or, “Oh yes I do.” This subsequently escalates the fear (increases the value of terminating such statements) on the part of the parent, as the child shows that she can be vindictive and spiteful (apply contingencies aversive to the foster parents). Their reaction to this type of behavior promotes the continued verbal assertion on the part of the child that she does mean it, or will do it, or is not sorry for saying that, and so forth. Again, in Polly’s case, this dynamic between child and adult only increased everyone’s belief that she has no conscience and may never develop one and, therefore, is someone to be feared. Of course, such a behavior probably will cut down on any future tendencies on the part of the parent to deny a desired activity or event to Polly.

I perceived my first job in this circumstance as one of teaching the foster mother to place these threats in context. This is not to say that I do not take these threats seriously. It was my contention that attempting to reason with her at that point in time only fuels the fire! What is needed from the parent is a refutation of such behavior as unacceptable, with a consequence for saying such spiteful things. I immediately set up a behavioral program, targeting threats with an early bedtime contingency. Each time she threatened, she was told that such statements were unacceptable in a firm manner (not inquiring as to why she would say something like that). The incident will be marked on the board in the living room. If she had more than three marks at the end of that day, then it was early bedtime that night (hey, it worked before, let’s keep using it).

30 Functional Behavioral Assessment, Diagnosis, and Treatment

How did this plan work? The data on the frequency of threats was the following (plan began on 6/7). Please note, that without baseline data being taken, data in Table 1.10 probably represent an immediate overall decrease in this behavior over the previous week.

As one can notice, Polly developed amazing self-control in her ability not to go over three threats in a day (maybe she developed a conscience each day as the day proceeded). Subsequently, the program was then changed to allow only one incident of threatening behavior before the early bedtime contingency was enacted. This produced the desired change in the behavior as weeks went by with no threats to family members at a month’s follow-up. The board had actually been put away, but the foster mother was instructed to initiate the planned contingencies again should threats develop again.

Fix One Problem, Get Another! However, as is often the case, as one problem gets solved a new problem develops “critical mass.” It began innocuously as Polly was asked by the FFA social worker if she wanted to see her brother and sister. Polly replied in the affirmative. Following that meeting, her behavior slowly escalated to refusal of all requests during the day, in the home. The reason offered (by the social worker) for this acting out contagion was that during the same meeting, Polly had dealt with sensitive abuse issues. Therefore, her behavior was a reaction to this “bringing up” of traumatic issues. In my experience, traditionally trained therapists often attribute the existence of problem behaviors to prior traumatic events, even after many years.

I inquired further, not feeling that this explained why Polly was being defiant. I would rather look for environmental factors that make such a behavioral pattern more functional in the current environment. I was more intrigued by the fact that this escalation coincided with her having a proposed visit with her siblings. Upon receiving this information, I first conjectured that maybe Polly did not want to see her siblings. Certainly acting out would be a functional way to get such a visit postponed (due to her bad behavior). However, I discarded that hypothesis when the foster mother relayed some information about what transpired after the talk with the social worker. She did not think this information was important at the time but now thought that it might help me in my quest to figure this out. The foster mother told me that Polly, subsequent to the meeting with the social worker, inquired over a several day period about the visit and wanted to know when it would happen. My hypothesis regarding her attempting to get out of the visit did not seem plausible. Rather she seemed eager to go. Then it hit me!

With the mention that she might get to see her siblings, Polly, being the 5-year-old that she was, translated that in the following 5-year-old’s English—“You absolutely positively will get to see your brother and sister; we have them en-route right now and they will

TABLE 1.10 n TARGET BEHAVIOR DATA

Date Frequency of Threats

6/7 3

6/8 3

6/9 0

6/10 0

6/11 2

6/12 2

6/13 2

6/14 2

6/15 1

1 Basic Concepts and Principles 31

be arriving in 5 minutes!” If you believed that your visit with your brother and sister was imminent, would you be upset if 15 minutes goes by and nobody arrives? How upset would you be when 1 whole day passes, 2 days, and so forth? Polly knows one powerful way to influence adult decisions. If you do not get your way, then utter profane words at someone in authority.

Another incident seemed to confirm this hypothesis. One day, Polly asked her foster mother if she could go to her friend’s house after school. The answer she got was not a “yes,” and not a “no,” but a “we will check it out” (i.e., “we will get back to you on that”). Well, once again that got translated into 5-year-old English, which probably went this way—“Oh what the heck. Just take the bus home with him tomorrow and I’m sure his parents will not mind.” The next day the foster mother gets a call from the parent of Polly’s friend, saying that Polly showed up with her son on his bus after school. Subsequent to the foster mother picking her up, Polly engaged in tantrum behavior that day and the following day (remember my hypothesis—when I don’t get my way, I’ll make it so miserable for you that you will have to give in).

In order to teach Polly not to react inappropriately when she wants something, she was taught that making a request for some item or activity will usually be honored at some point, provided she complies with some request or instruction from the foster mother. This procedure allowed me to build in a time delay from request to delivery of reinforcer. The type and number of tasks to be done depend on Polly’s request. For example, for a food item such as a piece of chocolate cake, Polly would have to possibly do several small compliant behaviors, such as picking up a few toys, washing her hands, and so forth. For a more extensive request, she may have to do something over a 2-day period. The foster mother was asked to keep track of the number of requests per day that Polly made, with a target goal of five to eight per day. The data for the first week showed that requests ranged from a low of two occurrences per day to a high of five.

The foster mother reported that the strategy was going well. I’m not quite sure she understood the necessity for this approach, and I therefore speculated that it was not being used as often as it should have been. Shortly after reporting that “things” were going well, this foster mother gave social service a 30-day notice on Polly for change of placement. As I suspected, “things” were not going well. The utility of teaching this skill is that if it is reinforced in the social environment (home), then inappropriate ways of getting items and activities will be replaced by this more acceptable and effective method. However, to utilize this, one must implement it at the time that demands are being made. One should not give into demands immediately, that is, without the “work” component, or deny them completely (except for untenable requests).

Case Analysis: What Does Polly Teach Us? In this case, I was struck by the forecasting of many people in the system. They attributed everything that Polly did, in terms of severe problem incidents, to Polly’s mental disorder. These professionals further prognosticated that such incidents would be repeated over and over again due to her RAD. I observed that this armchair philosophizing had resulted in not getting past theorizing and into the needs of solving the problem behavior. The parents and I were successful on several fronts in the short term when I looked past the predictions of what one could expect from a child with such a disorder. In contrast, I focused on what we would do when she engaged in such inappropriate behaviors. Apparently, children who are diagnosed with RAD can benefit from a contextual analysis of their problem behaviors.

One of the consequences of severe behavioral incidents is the child being moved from one placement to another. Foster children with severe disruptive and challenging behaviors have frequent changes in their residential placements. This occurs from a policy standpoint because the current care provider is not required to house the child. If her behavior is deemed too difficult for the provider to handle, she is moved to another placement. Often this is sanctified in the name of “finding the perfect fit.” But could behavioral contingencies be at

32 Functional Behavioral Assessment, Diagnosis, and Treatment

work in some of these cases where a child has six placements in 3 years, mostly as a function of the provider giving notice to terminate placement as a result of behavior?

It seemed to me that Polly would continually misbehave until she either got what she wanted (caregiver gives in to appease her) or she moved to a new home (where maybe she would get a better deal this time around ). The possibility that the change in placements might be a functional reinforcer did not strike me until I began reviewing the records of her prior placements. The pattern revealed that Polly would behave for a short honeymoon, where the new foster parents probably wondered why the previous parents had so much trouble managing this poor innocent child. However, they soon began gasping for air as this short honeymoon was followed by a downhill spiral of bad behavior and mean remarks.

Why would circumstances start off well and then turn south? Let us speculate that during the honeymoon period, her new foster parents are probably more lenient and likely to provide her with many of the items and activities she wants (hence, no need to act out). However, after a while, the parents begin to tighten the reins, and Polly starts to have problems. Over the long haul, when Polly did not get what she wanted, her misbehavior and hateful comments toward the caregivers would escalate and thereby force her case manager to find a new home for her because the current parents would no longer tolerate her behavior. I remember saying to the clinical supervisor of the FFA that we need to draw a line in the sand. The next placement needs to deal with this cycle of behavior without throwing in the towel at the end and moving her. The only way we are going to solve her problems in the long run is to not allow her misbehavior to alter her placement. What the system has taught Polly (at a very young age) is that extreme disruptive behavior, over long periods, makes you move to another house. From a behavior analysis perspective, the system needs to redirect such contingencies to not support severe misbehavior.

SELF-ASSESSMENT EXERCISES

• In the Behavioral Functions Involving Positive Reinforcement (Access Functions) section of this chapter, a number of hypothetical examples of a functional behavior-analytic approach are provided. Examine the case of Milton. Why does Milton pinch other clients? Does staff have something to do with that behavior?

• Illustrate how a problem behavior (specify the topography or form of behavior) can serve both an access function and then how the same form of behavior can serve an escape function.

• Provide an example of a direct access function. Now provide an example of a socially mediated access function.

• If food is an effective reinforcer, what behavior would be involved in a direct access function (i.e., describe the specific form of the DA behavior)? What might a socially mediated access function look like?

• If getting one’s hand stuck in a glass jar is an aversive event, describe what behavior would be involved in a direct escape function (hint: glass jar is breakable)? What about a socially mediated behavior that would also hopefully result in the hand being removed from the jar?

• Discuss what the establishing operation for an access functions is. Then contrast the EOs for access functions with EOs involved in escape functions.

• Delineate how a problem behavior of some topography can be functional under states of deprivation and also under states of aversion. Provide one example of each type of EO (deprivation state vs. aversive condition) and how the behavior produces a contingency that abolishes that EO.

• What makes a reinforcer a reinforcer for access functions?

1 Basic Concepts and Principles 33

Notes 1. I prefer to use the term direct (to be synonymous with the term automatic) to reflect the

behavior’s direct effect on the physical environment. 2. Dr. Jack Michael at Western Michigan University proposed a precise terminology that

designated the role of motivative variables as (a) an antecedent variable and (b) separate from the role of a discriminative stimulus (Michael, 1988, 1993). Motivating operations (MOs) are environmental events that affect an organism’s behavior by altering the reinforcing or punishing effectiveness of some environmental change (consequence) and the frequency of occurrence of the behaviors that have in the past been associated with the occurrence of those consequences. They differ from the layman’s terms motivation, desire, drive, or want in that they are quantifiable and verifiable changes in the person’s environment that affect the value of a particular outcome for that person. The first articles regarding these variables referred to motivative variables as EOs (Michael, 1983, 1988); however, more recent articles and text have labeled these variables MOs (Laraway, Snycerski, Michael, & Poling, 2003; Michael, 2007). MOs can be divided into two distinct operations (see Table 1.3): (a) EOs refer to the process by which the value of a particular outcome is increased; and (2) abolishing operations (AOs) refer to the process by which the value of a particular outcome is decreased. MOs affect the current rate of behavior by increasing (EO) or decreasing (AO) the value of the outcome associated with that behavior.

3. Clients or students can therefore become very “cognizant” of circumstances where staff/ adults who would be successful in encumbering their direct access/escape seem to be unable to perform such a duty at that point in time.

REFERENCES Bailey, J. S., & Pyles, D. A. M. (1989). Behavioral diagnostics. In E. Cipani (Ed.), The treatment of severe behavior disorders: Behavior analysis approach (pp. 85–107). Washington, DC: American Association on Mental Retardation. Barrish, H. H., Saunders, M., & Wolf, M. M. (1969). Good behavior game: Effects of individual contingencies for group consequences on disruptive behavior in a classroom. Journal of Applied Behavior Analysis, 2, 119–124. Cipani, E. (1990). The communicative function hypothesis: An operant behavior perspective. Journal of Behavior Therapy and Experimental Psychiatry, 21, 239–247. Cipani, E. (1994). Treating children’s severe behavior disorders: A behavioral diagnostic system. Journal of Behavior Therapy and Experimental Psychiatry, 25, 293–300. Cipani, E. (1995). Be aware of negative reinforcement. Teaching Exceptional Children, 27, 36–40. Cipani, E. (1998). Three behavioral functions of classroom noncompliance: Diagnostic and treatment implication. Focus on Autism and other Developmental Disabilities, 13, 66–72. Cipani, E. (2008). Triumphs in early autism treatment. New York, NY: Springer Publishing.

• Explain how a sufficient state of deprivation with respect to length of time playing computer games might be different for a 10-year-old versus a 66-year-old person.

• What antecedent condition must be present for an escape function to be viable?

• Read the Contrived Contingencies Produce a Function section of this chapter. What is the relevance of this section of the book?

• Provide your thoughts on the case of Polly, the 5-year-old child, described near the end of this chapter.

34 Functional Behavioral Assessment, Diagnosis, and Treatment

Cipani, E, & Cipani, A. L. (2017). Behavioral classification system for problem behaviors in schools: A diagnostic manual. New York, NY: Springer Publishing. Cipani, E., & Schock, K. (2011). Functional behavioral assessment, diagnosis, and treatment: A complete system for education and mental health settings (2nd ed.). New York, NY: Springer Publishing. Cipani, E., & Spooner, F. (1997). Treating problem behaviors maintained by negative reinforcement. Research and Intervention in Developmental Disabilities, 18, 329–342. Cipani, E., & Trotter, S. (1990). Basic methods of behavioral intervention. In E. Cipani & A. F. Rotatori (Eds.), A research annual: Behavior modification in special education (Vol. 7, pp. 137–201). Greenwich, CT: JAI Press. Greenwood, C. R., Hops, H., Delquadri, J., & Guild, J. (1974). Group contingencies for group consequences in classroom management: A further analysis. Journal of Applied Behavior Analysis, 7, 413–425. Inkster, A., & McLaughlin, T. F. (1993). Token reinforcement: Effects for reducing tardiness with a socially disadvantaged adolescent student. British Columbia Journal of Special Education, 17, 284–288. Iwata, B. A. (1987). Negative reinforcement in applied behavior analysis: An emerging technology. Journal of Applied Behavior Analysis, 20, 361–378. Iwata, B. A., Dorsey, M. F., Slifer, K. J., Bauman, K. E., & Richman, G. S. (1982). Toward a functional analysis of self-injury. Analysis and Intervention in Developmental Disabilities, 2, 3–20. Iwata, B. A., Vollmer, T. R., & Zarcone, J. H. (1990). The experimental (functional) analysis of behavior disorders: Methodology, applications, and limitations. In A. C. Repp & N. N. Singh (Eds.), Current perspectives in nonaversive and aversive interventions with developmentally disabled persons (pp. 301–330). Sycamore, IL: Sycamore Publishing. Keller, F. S., & Schoenfeld, W. N. (1950). Principles of psychology. New York, NY: Appleton-Century-Crofts. Laraway, S., Snycerski, S., Michael, J., & Poling, A. (2003). Motivating operations and terms to describe them: Some further refinements. Journal of Applied Behavior Analysis, 36, 407–414. LaVigna, G. W., Willis, T. J., & Donnellan, A. M. (1989). The role of positive programming in behavioral treatment. In E. Cipani (Ed.), The treatment of severe behavior disorders: Behavior analysis approaches (pp. 55–84). Washington, DC: American Association on Mental Retardation. Lennox, D. B., & Miltenberger, R. G. (1989). Conducting a functional assessment of problem behavior in applied settings. The Journal of the Association for Persons with Severe Handicaps, 14, 304–311. Michael, J. (1988). Establishing operations and the mand. Analysis of Verbal Behavior, 6, 3–9. Michael, J. (1993). Establishing operations. The Behavior Analyst, 16, 191–206. Michael, J. L. (1982). Skinner’s verbal operants: Some new categories. The Analysis of Verbal Behavior, 1, 1–5. Michael, J. L. (2007). Motivating operations. In J. O. Cooper, T. E. Heron, & W. L. Heward (Eds.), Applied behavior analysis (2nd ed., pp. 374–391). Upper Saddle River, NJ: Pearson. Neef, N. A., Shafer, M. S., Egel, A. L., Cataldo, M. F., & Parrish, J. M. (1983). The class specific effects of compliance training with “Do” and “Don’t” requests: Analogue analysis and classroom application. Journal of Applied Behavior Analysis, 16, 81–99. Sundberg, M. L. (1983). Language. In J. L. Matson & S. E. Bruening (Eds.), Assessing the mentally retarded (pp. 285–310). New York, NY: Grune & Stratton. Vargas, E. A. (1988). Event-governed and verbally-governed behavior. Analysis of Verbal Behavior, 6, 11–22.

35

2Functional Behavioral Assessment of Problem Behavior

Objectives

• Students will be able to delineate the procedures for a performance discrepancy analysis

• Students will be able to measure behavior with any one of several methods: frequency, dura­ tion, time sampling, and occurrence/nonoccurrence using the trigger analysis methodology

• Students will be able to use behavioral interviewing techniques to ascertain possible functions of problem behavior

• Students will be able to use scatter plot method to isolate high (and low) rates of problem behavior across the day which appear to be reliable across time

• Students will be able to identify trigger analysis test conditions, including the manipulation of the relevant establishing operation (EO) and use a three­column charting form for describing the EO, behavioral descriptions, and abolishing operation (AO) for the various functions

• Students will be able to identify and discuss the four conditions of the Iwata and colleagues’ methodology (i.e., multiple­EO hypothesis comparison)

• Students will be able to generate an analogue assessment which tests a specific hypothesis regarding function, consisting of two test conditions for different functions (i.e., single­EO hypothesis test)

• Students will be able to identify test requirements for an in­situ hypothesis test for different functions

Chapter 2 Behavior Analysis Certification Board (BACB) Task List

4th edition 5th edition

• G­01 Review records and available data at outset of the case

• G­02 Consider biological/ medical variables that may affect the client

• C­1 Establish operational definitions of behavior.

• C­3 Measure occurrence (e.g., count, frequency, rate, percentage).

• C­4 Measure temporal dimensions of behavior (e.g., duration, latency, interresponse time).

(continued )

36 Functional Behavioral Assessment, Diagnosis, and Treatment

This chapter delineates procedures, activities, and instruments that can be used for collecting functional assessment data on target problem behaviors. In addition to determining the baseline rate of occurrence for the target problem behavior(s), one must also collect data that provides evidence for the environmental function of the target behavior. A functional behavioral assessment (FBA) can involve multiple methods for assessing the problem behavior’s current function under specific antecedent motivating conditions and discriminative stimuli. This information then leads to the generation of a function-based behavioral classification for the problem behavior (Chapter 3).

DETERMINING THE NEED FOR INTERVENTION As will be evident, conducting an FBA is a time-consuming effort (as well as a monetary expense). Given this substantial effort, you should make an initial tentative determination as to the possible need for a comprehensive FBA. There may be state regulations that dictate when an FBA for a special needs student in a school system is required. Obviously such regulations and statutes, when codified into law, should be adhered to. With respect to other settings (e.g., residential facilities, inpatient units), a decision as to whether such a comprehensive assessment approach is clinically warranted needs to be made.

In emergency medicine, triage is the stage at which the professional makes a determination as to which patients are in need of immediate consideration and the relative needs of the remaining patients. Prior to extensive data collection activities, you should make a brief screening of the individual case. The following questions in Table 2.1 should help guide you in this phase of the assessment process (Barlow & Hersen, 1984; Kazdin, 1982).

Dangerous behaviors, such as aggression, self-injury, and property destruction, certainly warrant immediate clinical consideration because of their potential to impact the client’s (and others’) welfare and safety. Here is a case in point. I was a behavioral consultant to

4th edition 5th edition

• G­03 Conduct a preliminary assessment of the client in order to identify the referral problem

• H­01 Select a measurement system to obtain represen­ tative data given the dimen­ sions of the behavior and the logistics of observing and recording

• I­01 Define behavior in observable and measurable terms

• I­04 Design and implement the full range of functional assessment procedures

• C­5 Measure form and strength of behavior (e.g., topography, magnitude).

• C­7 Design and implement sampling procedures (e.g., interval recording, time sampling).

• C­9 Select a measurement system to obtain representative data given the dimensions of behavior and the logistics of observing and recording.

• C­10 Graph data to communicate relevant quantitative relations (e.g., equal­interval graphs, bar graphs, cumulative records).

• C­11 Interpret graphed data.

• F­1 Review records and available data (e.g., educational, medical, historical) at the outset of the case.

• F­2 Determine the need for behavior­analytic services.

• F­3 Identify and prioritize socially significant behavior­change goals.

• F­7 Conduct a descriptive assessment of problem behavior.

• F­8 Conduct a functional analysis of problem behavior.

• F­9 Interpret functional assessment data.

(continued )

2 Functional Behavioral Assessment of Problem Behavior 37

an adult day treatment program for persons with severe developmental disabilities. One of the clients came in one day with her neck raw from scratching. She had engaged in severe, intense, and lengthy self-abuse to her neck the prior afternoon and evening. I called up the residential facility and inquired what was being done to treat her. The response I received was, “We are taking baseline data.” I replied, “Your baseline has just ended and you better be intervening with her tonight!” The seriousness of this client’s behavior problem warranted immediate clinical attention. I suggested that whatever antecedent condition was producing this intense self-abuse should be halted until an effective plan could be designed. In this case, some effort at controlling the behavior must be considered prior to, or concurrent with, behavioral assessment activities.

Aggressive behavior poses the same immediate concern. If a student with severe intellectual disabilities occasionally bites his fellow classmates, such behavior obviously jeopardizes the welfare of other students in the class. Although it may require some time and effort to develop a comprehensive plan to effectively address this client’s behavior, steps should be taken immediately to ensure the safety of others. Closer vigilance of this student is most important; another temporary solution is reducing this student’s time around the other students. Although these strategies may not constitute the definitive manner in dealing with this situation, they do provide a short-term safety net.

The social significance of changing severe problem behaviors such as self-injury and aggression is obvious. However, the need for intervention goes beyond such drastic conditions. Some presenting problem behaviors are important to address because they prohibit a child or client from accessing a less restrictive educational, residential, or community environment or setting. For example, a young child’s inability to use the toilet independently, although certainly not a life-threatening behavior, may impact that child’s ability to attend a regular preschool program. Many would agree that attending preschool is an important step in developing requisite skills for success in early elementary grade levels. In many cases, young children with disabilities are precluded from entering private preschool programs if they have frequent toileting accidents or are not toilet trained at all. This is not to make a value judgment on such criteria, only to realize that many private preschools have such entrance criteria for all children being considered. As is the case with toileting, the presence of aggressive behavior can have the same impeding impact on a child’s ability to be educated in a more mainstream environment.

There are other behaviors that, when present, often result in some form of segregation of the child or client from environments with same-aged peers. A child who constantly gets out of his or her seat while riding the school bus, in spite of verbal admonishments from the bus driver to sit down, may eventually present a situation that calls for expulsion from the regular school bus. Although many children do occasionally get out of their seats, a child who repeatedly fails to heed the driver’s warning to stay in his or her seat creates a significant management problem. The school transportation personnel may press for alternate transportation arrangements to be made for this child, thus removing the child from this experience with same-aged peers.

Adult clients can also exhibit behaviors that result in their removal and segregation from the mainstream. An adult client with a diagnosed mental illness may be more than adequate at performing the requisite tasks in an employment situation with sufficient support from a job coach. However, the client’s behavior during lunch, breaks, or other social activities often can result in eventual termination of employment. For example, if the client bothers people while on break and such behavior reaches the level of what one person considers sexual harassment, then the client’s job is in jeopardy. The following real-life case scenario is evidence of seemingly innocent behaviors producing disastrous results (Cipani, 2004).

TABLE 2.1 n SCREENING QUESTIONS

• Does the individual’s behavior pose a danger to self or others?

• Does the behavior pose a health or safety hazard to the individual client or others?

• Does the behavior affect the client’s welfare in the current environment?

• Does the behavior prevent the individual from accessing less restrictive environments in either the school, home, or community settings?

38 Functional Behavioral Assessment, Diagnosis, and Treatment

THE CASE OF THE INTIMATE DISCLOSURE

In the early 1990s, we (myself and a behavioral specialist) received a referral for a 21­year­old female, Clarine, with a very unique but problematic behavior. Clarine had mild mental retardation and lived with foster parents subsequent to her being taken out of her father’s home (the reason will be apparent in a minute). She was a fairly capable and pleasant individual and could engage in a variety of tasks that would allow her to gain paid employment with some help. At the time of the referral, she was working at a convalescent hospital and was being trained by an agency to gain and maintain that place of employment.

Her work at the hospital seemed to meet everyone’s expectations, but she was to be fired from her job for a reason other than her ability to make a bed. Clarine made friends easily, perhaps too easily. She would initiate a conversation with the patients at the hospital in an appropriate manner (this attention is often a welcome event in these patients’ lives). However, without a moment’s notice, she would begin talking with them as if they had been hired as her psychiatrist or social worker. For example, in mid­conversation, Clarine would provide explicit details about her biological father sexually abusing her (in graphic details) as well as a rape that occurred to her when she was in school. The conversation might start with, “Hi, my name is Clarine. What is your name? How are you doing? Do you like it here? Do you want to hear how my father undressed me and ———?”

The staff person who worked with her had tried many strategies to get her to stop disclosing all the intricacies of her unfortunate past, but to no avail. This staff person must have felt like she was swimming upstream in her attempt to get Clarine to desist. Imagine the reaction you would have if you were a patient in this hospital. Here comes a pleasant individual who wants to converse with you. Your agenda is not entirely filled up on this particular day, so you greet her with a smile. The conversation is pleasant and seems to be going along fine, and then you do a double take, discounting the possibility that you heard ———. Nope, there is nothing wrong with your ears. Your smile turns to a look of apprehension and, finally, distaste. As you might guess, Clarine did not pick up on some subtle cues that your interest had turned to aversion to her story. The patient’s attention was all that mattered, and this was being given in abundance because of Clarine’s remarks about her unfortunate past life.

To complicate matters, this probable attention from patients would make it more difficult to eliminate such a behavior. One could not count on this attention to stop in the near future. It would be improbable to get everyone at her worksite, as well as visitors, to agree to ignore this one worker when she revealed her shocking story. I don’t believe the Americans with Disabilities Act would extend that far in terms of a reasonable accommodation. This situation required that we come up with a strategy that would make it more uncomfortable for her to engage in this behavior and override the social attention it received.

The administrators at the hospital were adamant about her leaving, and they fired her. Luckily, another job at a day care center was procured by her social worker. My behavioral specialist and I felt that it was essential to have a plan in place that would be so powerful that it would make Clarine think twice before launching into her sermon. Prior to Clarine showing up at her new position, my behavioral specialist worked with the foster parents to teach them how to use evening privileges as a consequent event. If Clarine had an incident at work that day, all evening privileges were revoked. She would basically become bored until she went to sleep that night. Tomorrow was another day when she could keep or lose that evening’s privileges.

What would she have to do to lose evening privileges? You guessed it. Each day, the supervisor would meet with Clarine’s staff aide to determine if there had been any incidents of inappropriate conversation. If any incident occurred, this was conveyed to her parents, and privileges were revoked that evening. Conversely, if she kept her conversation appropriate, then she did not lose evening privileges. Additionally, any chores at work that were assigned and not completed due to lack of motivation on her part would also result in her evening privileges being revoked.

Apparently, this consequence struck fear into Clarine. Not one single major incident of inappropriate disclosure occurred at the day care center within the first 2 months. This plan

2 Functional Behavioral Assessment of Problem Behavior 39

TABLE 2.2 n �INTERVIEW QUESTIONS ON RELEVANCE OF PROBLEM BEHAVIOR FOR MAINSTREAM ENVIRONMENTS

1. What specific behaviors define the problem? On the surface, would such behaviors pose a problem for current (or future) educational, work, or residential mainstream environments? Is the problem behavior inappropriate in mainstream environments with people or children of similar age to the client? What are the ramifications of the problem behavior for the client’s ability to live, work, attend educational opportunities, and/or play in inclusive settings?

2. Does the frequency or type of problem behaviors restrict the client’s access to activities, events, and people that are of some reinforcing value in the current environment? For example, is the client often prevented from accessing community events because of his or her behavior when in the community?

3. What are the standards of social behavior that the current (or future) environment has in place? Are they in writing or are they implied? Is there some variation on these standards or are they strictly enforced?

was effective because it provided a powerful consequence for inappropriate disclosure as well as a reinforcing condition if she did not disclose such facts while at work.

This case is instructive for another reason as well. Sometimes, a punishing consequence has to be used to override the effects of a powerful social reinforcer that the behavior automatically produces because people are people! When some people do or say wacky things, other people stand up and take notice, and laugh and attend. Overriding this built­in reinforcement for intimate disclosures required the foster parents to remove preferred events when such occurred. Although other people may have felt that Clarine needed to talk about this earlier trauma in her life, my position was that its indiscriminate occurrence was not healthy for anyone. Subsequent to the success of this program, I do not see that Clarine’s emotional health suffered because we punished such a disclosure. In fact, Clarine was better for it, and I’m sure the day care center was also happy with the result.

Taken with permission from Punishment on Trial, by E. Cipani, pp. 115–117, e­book in its entirety is available as free download at the APA Division 2, Office of Teaching Resources in Psychology, teachpsych.org/Resources/Documents/ otrp/resources/cipani09.pdf (or other Internet sites)

Table 2.2 includes some questions to consider when determining if the problem behaviors are jeopardizing current or future mainstream environments in students and clients. In assessing the impact of the problem behaviors of students in educational settings, consider how such behaviors ameliorate or eliminate the potential to be educated in a less restrictive educational placement. In assessing the impact of the problem behavior in clients living in residential settings, examine how the problem behavior affects their ability to live in more mainstream environments.

Once the need for an assessment has been established, a number of activities and data collection efforts should be conducted. The steps in Table 2.3 certainly are not presented as an invariant sequence. Very often, several assessment activities may be undertaken concurrently. Reviewing health and medical records and possibly involving a medical consultation can be done concurrently with pinpointing a problem behavior. Use the steps shown in Table 2.3 to ensure that each step is covered during your behavioral assessment. This assessment phase involves the collection of data and information. The selection of a classification depicting the behavioral function for the problem behavior is left for the diagnosis stage, which will be explicated in Chapter 3. Subsequently, a function-based treatment is designed and implemented following the diagnosis stage (see Chapter 4 for details). Hence, the ordering of these chapters is sequential in terms of the process of assessment, classification, and treatment.

40 Functional Behavioral Assessment, Diagnosis, and Treatment

BASELINE MEASUREMENT OF OBSERVABLE PROBLEM BEHAVIORS In an FBA, the critical first step is to define the presenting problem in discrete, observable behaviors. Very often in clinical and educational settings, client problems are phrased in ambiguous terminology. As an example, consider the following referral for behavior problems in a hypothetical school classroom: “John Smith, a third-grade mainstreamed student with anger issues, is reported by his teacher to be uncontrollable and incorrigible!” This lack of specifics on what constitutes “uncontrollable” or “incorrigible” is all too frequent from persons making referrals for a behavioral assessment.

What is wrong with this type of information? It requires that you get to the bottom of the child’s problem by obtaining specifics of the problem behaviors. Unobservable behaviors, personality characteristics, or traits do not constitute the primary criterion for measurement of behaviors in an FBA, even though they make us sound more “clinical” in our conversation. Your first task is to take the unobservable entities often provided by the referral agent and define them into discrete, observable, and measurable behaviors. This is called pinpointing a target behavior. The pinpointing of observable target behaviors can be obtained by one of two methods: (a) behavioral interviewing and (b) direct observation (by you).

Very often, initial data gathering is gained through a behavioral interview of significant others who are directly involved with the client in everyday life. These relevant individuals can be parents, care providers, teachers, facility staff, siblings, and friends or peers (in some cases), depending on the setting or settings in which the problem behavior is occurring. For the present concern, the purpose of behavioral interviewing is to identify observable behaviors that appear to constitute the reason for the referral. Following is a list of behaviors you would have to pinpoint further in observable, measurable terms:

�l Hyperactive �l Oppositional �l Lazy �l Uncaring �l Unappreciative �l Disturbed �l Undersocialized �l Emotionally labile �l Forgetful �l Impulsive �l Spiteful �l Aggressive

TABLE 2.3 n FIVE STEPS TO COLLECTING FBA DATA

1. Obtain a baseline measurement of observable problem behaviors.

2. Conduct an FBA.

3. Perform a discrepancy analysis.

4. Review previous treatments.

5. Review health and medical records.

FBA, functional behavioral assessment.

2 Functional Behavioral Assessment of Problem Behavior 41

�l Angry �l Schizophrenic �l Borderline personality

Why is it important to pinpoint such terms? Can one conduct an FBA on a child’s hyperactivity? Absolutely not. Ambiguous terms lead to unreliability in recording the frequency of behavior. If the rate of the target behavior cannot be counted on to be accurate (reliable) from one day to the next, how can any other information that is tied to such data be accurate? It cannot! What happens if you attempt to conduct an FBA of an unobservable vague entity instead of a pinpointed target problem behavior? You get a bumper sticker slogan: Garbage in, garbage out!

One useful technique to utilize in a behavioral interview to pinpoint specific observable behaviors is called the Incident Method. Using the Incident Method, you try to get the interviewee to specify incidents that represent the referred problem or trait being presented. For example, if the referral source indicated that a child was incorrigible, you would ask the referral source to identify previous events or incidents that were representative of the child’s incorrigibility. This often leads to specific observable behaviors and usually identifies the antecedent conditions for the behavior.

As an example, Table 2.4 shows some questions you might pose to help uncover the observable behaviors that constitute the reason for the referral of the child who was uncontrollable and incorrigible. If the person being interviewed still uses unobservable terms when describing the child or client, stop at that point in the conversation and ask the person to describe specifically what the child did or did not do. I often use the phrase “Tell me what I would have seen the child do if I was there.” Eventually, one can get down to specific observable behaviors using this method.

The Incident Method is very useful from the standpoint of time and efficiency. However, in some cases, the Incident Method may not yield the specific observable behaviors that are deemed problematic. A second effective method to help pinpoint observable behaviors is to schedule time to observe the client when it is highly likely that the client will exhibit the behavior of interest. With the aid of the referral sources indicating times when the behavior problem is most likely, you can directly observe the problem behavior in the setting of interest. Subsequently, you can formulate a definition of the problem behavior in observable terms that matches what you observed. If the behavior problem is highly frequent, so that one can view a number of

TABLE 2.4 n �QUESTIONS USED TO “PINPOINT” WITH THE INCIDENT METHOD

1. Can you remember a time when (the child) was incorrigible? For example, was the child incorrigible anytime today? If so, what happened?

2. Describe to me the circumstances that occurred at this time.

3. What did you consider in this incident to be representative of the child’s incorrigibility?

4. Are there any other circumstances that reflect that same attitude or behavior? If so, describe exactly what happens.

5. Are there any other incidents of behavior that you feel I should be aware of and that possibly shed more light on his or her demeanor? If so, paint me a picture of that (those) incident(s).

DISCUSSION QUESTION 2A

1. Hyperactivity is not a pinpointed behavior. Yet, you may receive a referral for a child with hyperactivity listed as the problem. Detail how you would decide what observable behaviors define a particular child’s problem of hyperactivity.

42 Functional Behavioral Assessment, Diagnosis, and Treatment

occurrences in a short (30–60 minutes) session, this second method may be preferable to the Incident Method. However, some circumstances may preclude direct observation of the client in natural environments for a long enough period. In these circumstances, an initial definition of the problem behavior may need to be obtained through the Incident Method.

MEASURING OBSERVABLE BEHAVIOR Once a behavior has been pinpointed, you need to identify and select a method of quantifying the level of the behavior. Methods of measuring and quantifying the level of behavior are presented elsewhere in greater detail (Alberto & Troutman, 2006; Martin & Pear, 2007; Miltenberger, 2004) but basically include the following: frequency of occurrence, duration (or length of time), and percentage of occurrence (interval recording methods). Collecting such data has been termed baseline assessment.

Frequency is the most common measure of behavior because it is the least complex. Frequency counts merely require that someone count (and record) the number of times a behavior occurs. Table 2.5 presents hypothetical data for three target behaviors across a 3-day period for a 5-year-old girl living with her adoptive parents. Note that on 9/21 the girl had three instances of tantrums (defined as yelling, screaming, threats to parent, kicking walls and furniture), five instances of verbal refusal (defined as verbally refusing to follow a parental instruction to complete a task, chore, or assignment), and no instances of hitting either of her two siblings. Data similarly were collected on the same target behaviors for 9/22 and 9/23.

Duration measurement requires that one measure the length of time a behavior occurs. Therefore, such a measurement system requires a timepiece of some kind (e.g., stopwatch, second hand on a watch). For that reason, duration measures are not frequently used in classrooms, residential settings, or community and work environments.

Table 2.6 shows the duration of each episode of target behavior. On 9/2, the client had two verbal outbursts: one of 50 seconds and one of 1 minute and 25 seconds in length. The client also left the area unauthorized three times on 9/2, one time for 3 minutes, one time for 33 minutes, and the last instance for 65 minutes.

Duration measures are preferred when the target behavior occurs across varying time frames. For example, in Table 2.6, the range of leaving area unauthorized on 9/2 is from 3 minutes to 65 minutes. To depict such a phenomenon as occurring only three times is to

TABLE 2.5 n FREQUENCY OF THREE TARGET BEHAVIORS FOR A 5­YEAR­ OLD GIRL IN THE HOME

Date Frequency of Tantrums Frequency of Verbal Refusal

Frequency of Hitting Siblings

9/21 xxx xxxxx 0

9/22 0 x 0

9/23 xxxx xxxxxx x

TABLE 2.6 n �DURATION OF TWO TARGET BEHAVIORS FOR A 25­YEAR­ OLD CLIENT IN AN INPATIENT TREATMENT FACILITY

Date Duration of Verbal Outburst/Tantrum

Duration of Leaving Area Unauthorized

9/1 (25″) (16″) (21′) (7′) (17′) 9/2 (50″) (85″) (3′) (33′) (65′)

2 Functional Behavioral Assessment of Problem Behavior 43

TABLE 2.7 n FREQUENCY DATA SHEET FOR TWO PROBLEM BEHAVIORS

Child’s Name: Lorenzo Vittorio Baseline Condition Date

Problem Behaviors

Verbal abuse to peers Threatening gestures to peers 3/16 xxxxx xx x 3/17 xx xxx 3/20 xxxxx xxxx xxxx

TABLE 2.8 n DEFINITIONS OF COMMON CLASSROOM PROBLEM BEHAVIORS

Reference Behavior/Definition Hall, Lund, and Jackson (1968) Study behavior

Orientation toward appropriate person or object Thomas, Becker, and Armstrong (1968)

Disruptive behavior: Gross motor Getting out of seat, running, hopping, rocking, moving chair Noise making Tapping feet, clapping, rattling, slamming or tapping objects on desk Orienting Turning head or body away from teacher Verbalization Conversation with other students, calling out the teacher’s name, coughing loudly Aggression Hitting any part of self or another person

(continued )

miss the fact that two of those episodes were quite lengthy. Although three tantrums on a given day for this client may seem reasonable, when they last for long periods, a significant problem exists. To not portray the duration data with a client and target problem such as this would probably misrepresent the nature and extent of the problem. In these cases, frequency data alone is insufficient as an accurate method of portraying the extent of the target behavior.

Percentage of occurrence is very popular with test items or situations where a client is given a certain number of opportunities to do something, and one can therefore measure the number of times a behavior occurs over the total number of opportunities. Percentage of occurrence is also utilized in interval-recording systems, but such systems are too labor intensive to be considered in most applied settings. In most applied settings, frequency data are the most often collected data due to the impracticality of the other methods and will be primarily addressed in this section. The following hypothetical example provides another data sheet illustrating the frequency of two problem behaviors for an adolescent male in a residential treatment center.

The staff at the facility records the number of incidents of the two behaviors in Table 2.7: (a) verbal abuse to peers and (b) threatening gestures to peers. The data sheet is kept on a desk or a clipboard. Whenever Lorenzo exhibits either or both behaviors, the staff put one mark in the appropriate column and row (behavior and date of occurrence). The data sheet in Table 2.7 indicates that Lorenzo had seven instances of verbal abuse on 3/16 and one incident of threatening gestures toward a peer. For school personnel, a number of problem behaviors with definitions from research studies is provided in Table 2.8.

44 Functional Behavioral Assessment, Diagnosis, and Treatment

Reference Behavior/Definition Zeilberger, Sampen, and Sloane (1968)

Bossing Directing another child or adult to do (or not do) something

Hart, Reynolds, Baer, Brawley, and Harris (1968)

Cooperative play Examples listed in article

Madsen, Becker, and Thomas (1968)

Inappropriate classroom behavior Examples listed in article Appropriate behavior Time on task

Phillips (1968) Aggressive statements Examples listed in article Punctuality Examples listed in article Poor grammar “ain’t”

Sailor, Guess, Rutherford, and Baer (1968)

Tantrum behaviors See article

Walker and Buckley (1972) Attending behavior (on-task) Looking at assignment pages, working problems,

recording responses Nonattending behavior Those incompatible with above

Ward and Baker (1968) Disruptive behaviors See article Motor behavior (at seat) Gross motor behavior (not at seat) Aggression Deviant talking Nonattending disobedience Thumb sucking Hand raising

O’Leary, Becker, Evans, and Saudargas (1969)

Disturbing another’s property Tearing up others’ paper(s), grabbing their book(s) Inappropriate tasks Working on spelling during math, doodling

Zimmerman, Zimmerman, and Russell (1969)

Instruction-following behaviors 30 instructions, see article

Barrish, Saunders, and Wolf (1969) Talking out, out of seat Wahler (1969) Oppositional behavior

Failure to follow request of parent Schmidt and Ulrich (1969) Classroom noise

Sound­level meter 42 dB or higher Cantrell, Cantrell, Huddleston, and Woolridge (1969)

Assignment completion

Schutte and Hopkins (1970) Instruction following (kindergarten) 10 common instructions

Bailey, Phillips, and Wolf (1970) Rule violations 6 rules in article

TABLE 2.8 n DEFINITIONS OF COMMON CLASSROOM PROBLEM BEHAVIORS (continued )

2 Functional Behavioral Assessment of Problem Behavior 45

CASE EXAMPLE

Maria, an adult female diagnosed with schizophrenia who resides in an inpatient unit at a mental health facility, is described by Ms. Johnson as decompensating. After several months of case conferences and different milieu treatments, Maria’s condition does not improve. A behavioral consultant, Dr. Kellog, is contacted to consult with staff. The staff report to Dr. Kellog that Maria used to be more responsive to her social environment. Her global assessment of functioning (GAF) scale score on Axis V of the DSM IV-TR (American Psychiatric Publishing, 2000) manual was 65, now it is 30. She has continued to “decompensate.” Staff provide the behavioral consultant nursing progress notes from the last 3 months. These records have various remarks about her eating habits and interactions with staff and other residents. Although there are hints of some problem behaviors in these notes, they are inadequate for Dr. Kellog’s need for specific target behaviors. Further, such notes do not provide a baseline measurement of such behaviors. Social withdrawal appears in several entries. Unfortunately, there are no definable behaviors that delineate what Maria does (or  does not do) when she exhibits social withdrawal. Was she curled up in a corner? Was she not getting out of bed? Did she not respond to someone’s verbal initiation to her? The nursing notes do not clearly specify the behavior problems.

After interviewing staff and utilizing the Incident Method, Dr. Kellog surmises that three behaviors may be at the heart of Maria’s problem, which was described by staff as “decompensating.” The target behaviors that were deemed to be problematic are the following: (a) physical aggression, (b) making hallucinatory statements, and (c) failure to engage in and sustain social conversations with staff or peers. Physical aggression was defined as striking or pushing another person. Hallucinatory statements were defined as verbal statements referencing auditory events that were not observed by others who were in the area. Sustaining conversations was defined as any time that the client initiated and sustained an appropriate conversation with a staff person or other client on the unit. With this information, the following data were collected across the period of 4/13 through 4/21 (see Table 2.9).

In viewing the data, one can see that there are days when physical aggression is high, as is the frequency of hallucinatory statements. It is quite possible that the increase in these two behaviors combined with a low frequency of initiating and sustaining appropriate conversations is leading to the judgment by professional staff that Maria is decompensating. However, now it is clearer what target behaviors need to be addressed with a behavioral intervention plan. Defining the behavior of interest is very important!

TABLE 2.9 n DATA FOR MARIA

Date Sustained Physical Aggression

Hallucinatory Statements

Conversations

4/13 10 6 2

4/14 5 3 3

4/15 5 3 1

4/16 2 9 0

4/17 3 12 0

4/18 9 16 2

4/19 1 0 0

4/20 0 1 3

4/21 2 11 0

46 Functional Behavioral Assessment, Diagnosis, and Treatment

It is helpful to provide the person(s) at the sites with the tools to collect the baseline observation data of the client. The following is a list of tools that facilitate the collection of baseline data:

1. Wrist counters (for frequency measures) 2. Data sheets 3. Stopwatches (for duration measures) 4. Tape recorders (for frequency measures) 5. Laptop computer or PDA 6. iPhone or Blackberry

Is behavioral data collection just as important in psychiatric and mental health facilities? Of course. Such data collection is just as crucial to the understanding of the client’s problems. Examine the following scenario of a hypothetical client in an inpatient unit whose social worker reports that she is “decompensating.” If the professional staff do not get more explicit, intervention will be difficult. Unless specific observable measures of actual behaviors are being measured, one does not have the slightest idea of what problems need to be addressed.

It is important to collect the rate of occurrence of a problem behavior in the baseline assessment period. However, schools and agencies have found that it often is not perceived as important by personnel who are asked to collect such data in addition to their other duties (whether this perception is valid or not). As a result, data collection may not be conducted in a timely fashion, if at all. To make everyone’s life simpler in these circumstances, let us look at some possible solutions to this dilemma.

Rather than having the teacher, staff person, or parent collect continuous data (observing for the behavior all the time), you might consider a time-sampling data collection method. In some cases, the behavior being targeted is so infrequent and distinct that one can easily measure its occurrence whenever it happens, for example, loud tantrums in the classroom. In these situations, asking for each occurrence may not be perceived as a difficult or unreasonable request. However, in some cases where the behavior occurs more than several times an hour (an estimate can be provided by the interviewee), asking personnel to collect data for each occurrence may give them the impression that you are demanding and unaware of their other responsibilities. In these circumstances, you can have the person collect data on a limited sample of the total length of time.

For example, if you were interested in collecting data on a child’s rate of disruptive behaviors during class time, you would sample possibly three to five, 15- to 20-minute time periods across a 1- or 2-week period. Note that you can be flexible here. It doesn’t have to be exactly three or five sampling periods, nor does it have to be 20 minutes each time, and you can extend the length of time needed to collect the data from 1 to 2 weeks (for that matter, if need be, 3 weeks). Flexibility is appreciated in applied settings, and inflexibility is often punished by personnel failing to follow through on your requests and avoiding you in future circumstances.

A second possibility to collect baseline data when a continuous measure may not be feasible is to conduct a trigger analysis (A. Rolider, 2003; A. Rolider & Axelrod, 2000). In this method, you present the antecedent motivating condition that you suspect “triggers” the problem behavior (i.e., hypothesized deprivation or aversive EO). The data collected during each trial is the following: Did the behavior occur (occurrence), or not (nonoccurrence)? If you present this “trigger” 10 times over a 1-week period, you can determine what percentage of times the problem behavior occurs to the trigger. Of course, you should have a reasonable suspicion that such an EO creates either a sufficient state of deprivation or a relative aversive state. But sometimes, contriving a motivational condition is not feasible, or you may not receive authorization to conduct such (via informed consent). When the EO is predictable in the real-life context, the behavior analyst might just study and describe the behaviors under these natural routine conditions.1

The clinician can induce the EO condition in the real-life context with the existent personnel (with written informed consent). With deprivation EOs, the motivational condition can be created by interrupting/halting a preferred activity or taking away a desired item. When the circumstance arises, another approach to creating an EO is to not honor a request for a specific item or activity, thus creating an EO at that point in time. In the

2 Functional Behavioral Assessment of Problem Behavior 47

case of aversive EOs, the stimulus condition is presented by the staff person at the request of the clinician. All of these methods of creating an EO involve active manipulation of an environmental variable; hence, such constitute an experimental analysis.

Here is a hypothetical example of contriving an EO for a trigger analysis assessment. Let us say you are referred an adult male with developmental disabilities in a community-based program. The case manager reports that the client does not cooperate with coworkers when asked. You spend several hours over two afternoons watching him. Disappointingly, these direct observations do not provide sufficient opportunities to view his uncooperative behavior in the natural context. As a result of the client’s lack of cooperation, such opportunities are rarely presented by staff (because they predict the outcome of such encounters and “don’t bother”).

You determine that contriving a situation may provide the needed information on this client’s problem in a more timely fashion. To assess the client’s ability to cooperate, as well as the presence of possible unacceptable behaviors, you set up the following situation with help from the client’s coworkers. They will present the client with the opportunity to cooperate with them in a task, such as helping them pick up the tools at their workstation. You would make sure that tools were left out to set up the condition for social interaction. Further, you coach the other workers to make a request of the client to help them pick up the tools. It then becomes easier to determine if cooperation occurs (or not) in these contrived conditions. These tests can be designed over several different situations (helping at the lunch table, helping with other work tasks, etc.) until you feel you have a handle on this client’s rate of cooperative behavior.

A trigger analysis is particularly suited in examining the rate of relatively infrequent problem behaviors. With low-rate behaviors, it may take weeks (or months) to observe a single instance of target behavior. However, if you are reasonably certain that such a low- rate behavior is triggered by a relatively infrequent event in the environment, then a trigger analysis is a great method to study such a behavior. In order to conduct the trigger analysis of low-rate problem behaviors, you may have to expose the client or child to the motivating

TABLE 2.10 n PRESENTING SUSPECTED “TRIGGERS” FOR TARGET PROBLEM BEHAVIOR

Child Suspected EO Presented Stimulus Condition

Across Different Settings and/ or Persons

Ratio of Occurrence of Target Behaviora

8­year­old girl who infrequently screams violently at adults (form makes it a problem)

Interrupting child during preferred event

When child is engaged in favored activity, interrupt her with a question or request

School, home, park, mom, dad, teacher

6/8 times with mom, 3/4 times with teachera

5­year­old girl who bangs her head on floor once every few months

Withholding desired item, child required to wait

Ask child to wait contingent upon a request for a favored item

Mom, dad, older sibling

5/5 with older sibling, 1/3 times with dada

11­year­old boy with developmental disabilities who destroys personal property three times a year in tantrum episodes

Giving child nonpreferred event

When child asks for an item, give him a less preferred item instead

At school across different teachers and aides

1/5 with aide, 2/7 times with teacher, 4/4 times with substitute teachera

aNumber of times problem behavior occurs to the EO/total number of times the trigger was presented.

48 Functional Behavioral Assessment, Diagnosis, and Treatment

condition (present aversive stimulus or sufficiently deprive access to reinforcer) prior to the presentation of the trigger. This is termed presession exposure to the EO or AO (N. U. Rolider, Iwata, & Camp, 2006) and allows for more probable conditions for target behavior to occur.

Table 2.10 presents a chart illustrating how one would conduct a trigger analysis for three suspected EOs for three different children across a 1-week period. You will note that in the first two hypothetical examples, the data indicate that the behavior analyst has identified the antecedent condition that acts as an EO (see ratio of occurrence in last column). In the third example, it would seem something else is triggering (another EO or discriminative stimulus) the behavior. A variation of this technique will be presented again later in this chapter as it relates to uncovering possible functions of problem behavior and the relevant EOs underpinning a suspected function.

WHAT IS BASELINE DATA? The result of this first step in the behavioral assessment is the production of the baseline rate of occurrence for the problem behavior. Baseline data is the measurement of the target behavior in its current natural state prior to the proposed intervention (Alberto & Troutman, 2006; Martin & Pear, 2007; Miltenberger, 2004). Baseline data presents the level of the target behavior prior to the intervention and reflects the level of behavior under the current conditions, whereby such a level of behavior would be predicted in the future should the baseline conditions remain in effect.

How long should one collect baseline data? There is no set definitive answer. Rather, baseline data should be collected for as long as necessary for a reliable pattern to emerge. If the data are trending up or down, it is essential to continue collecting baseline data until some stability is achieved.

A sample summary data sheet for a hypothetical 6-year-old child across 8 days of baseline data collection for three different behaviors is presented in Table 2.11. This data sheet indicates

Simulation Exercise: Data Recording

Select several target behaviors that are easy to perform, for example, scratching your ear, writing on paper, and so on. For those that are suitable for frequency measures, perform such (along with other behaviors) in a 3-minute period. Observers record the frequency of target behaviors selected and then compare their results at the end of the session. Conduct several such mini-sessions to allow a practice effect, as well as the calculation of interobserver agreement, if desired.

TABLE 2.11 n SAMPLE FREQUENCY DATA SHEET FOR PROBLEM BEHAVIORS IN HOME

Date Tantrum Behavior Leaving the House Noncompliance

4/13 10 6 9

4/14 5 3 5

4/17 3 0 2

4/18 9 1 3

4/20 6 4 4

4/21 5 5 7

4/22 6 4 5

4/25 7 5 7

2 Functional Behavioral Assessment of Problem Behavior 49

the rate of tantrum behavior on 4/13 was 10 occurrences. The rate of leaving the house on the same day was six times, whereas the rate of noncompliance was nine times.

Baseline data have several purposes. First, baseline data give you a quantitative view of the level of the target behavior at the current level. In contrast to someone saying “it happens a lot” when questioned how much a behavior occurs, one can quantitatively represent the level of the behavior. Second, it provides you with a basis for comparison when deploying a treatment. If the rate of the target behavior of toileting accidents is between 1 and 4 per day (mean of 2), a comparison between the problem behavior before treatment and after is possible. One can see that a treatment to address toileting accidents that results in one to two per week produced substantial improvement. Such a treatment is well worth maintaining until the behavior can be under control over naturally occurring contingencies. Finally, it often is used in designing the initial behavioral criterion for reinforcement for both the target problem behavior as well as the replacement behavior.

CONDUCTING AN FBA With the first step, you have now identified how frequently the problem behavior is occurring. You have collected the baseline level of target problem behavior. However, so much more needs to be understood before you are ready to develop a hypothesis about the reason for the client’s behavior and, further, what functional behavior analytic treatments are best suited for these circumstances. For example, knowing that a child is noncompliant to parental requests from 30% to 60% of the time across five baseline sessions does not provide any information on why he is noncompliant. It merely tells us that his level may be unacceptable (depending on his age). What is also needed is information that reveals the purpose or function this behavior serves in the client’s current environment. Determining the environmental purpose a problem behavior serves cannot be gleaned from data presenting its rate of occurrence only. One needs to collect additional information that provides clues as to the environmental events responsible for the maintenance of the problem behavior. The FBA process of determining the function or purpose of a problem behavior is a requisite for functional treatment.

You generate a hypothesis about the reason for the maintenance of problem behavior prior to prescribing a treatment. This hypothesis is generated when certain questions are answered (tentatively, of course) through one or several behavioral assessment methods that are designed to uncover a problem behavior’s current function (i.e., maintaining contingency). Based on your hypothesis about the function of the behavior, you then can select a treatment strategy for the problem behavior that addresses the functional characteristics of the problem situation.

Table 2.12 illustrates the role of hypothesis generation in a case of noncompliance. The selected hypothesis leads in selecting a designated treatment that will be unique to

DISCUSSION QUESTION 2B Explain how the aggressive behavior of a hypothetical 12-year-old child can require two different behavioral treatments. Why would different treatments be needed for the same target behavior?

TABLE 2.12 n HYPOTHESIS GENERATION

Hypothesis Functional Treatment

Noncompliance maintained by function A

→ Specific treatment for problems maintained by A

Noncompliance maintained by function B

→ Specific treatment for problems maintained by B (different from above)

50 Functional Behavioral Assessment, Diagnosis, and Treatment

that  hypothesis regarding the current environmental function or purpose of the target behavior.

One caveat needs to be made in determining the function(s) of the problem behavior. Selecting a hypothesis regarding the maintenance of the behavior does not mean that you have identified the original factor in the genesis of the behavior. The reason for the current maintenance of a behavior could be quite different from its original cause. Your focus is on the current maintaining contingencies. You examine the existing conditions of the problem behavior and determine that the recorded level of the problem behavior is being maintained as a result of its current purpose or function.

There are at least five common methods, varying in form and reliability, for collecting evidence via an FBA: (a) behavioral interviewing, (b) A-B-C descriptive analysis method, (c) scatter plot data, (d) analogue assessment, and (e) in-situ hypothesis test. An additional sixth method that is not popular yet, but can be of great utility, is the trigger analysis with behavioral description.

Behavioral Interviewing Directly observing the referred child or client in the natural setting is always the most preferable approach to collecting data. However, very often you may find yourself relying, to some extent, on a behavioral interview in an attempt to analyze a problem behavior’s function, particularly in the initial stages of a referral. Behavioral interviews can be useful in uncovering the problem behavior(s) maintaining contingencies, given the right questions. Additionally, they can provide information that enlightens your selection about what other FBA methods to use to complement the interview. For example, hypothesized functions derived from behavioral interviewing can be readily followed up with a trigger analysis in the natural context.

In conducting a behavioral interview, the people primarily involved with the child or client in the specific setting or settings (e.g., parents, teachers, therapists, staff) are interviewed. In collecting interview information on why a problem behavior is occurring, you examine the relationship between the behavior and some consequent event. Your use of specific questions can help you discern possible functional relationships between the problem behavior and the current maintaining contingencies. Table 2.13 presents general questions aimed at discerning if the problem behavior serves an access function, whereas Table 2.14 presents questions for an escape function.

TABLE 2.13 n QUESTIONS FOR ASCERTAINING AN ACCESS FUNCTION

1. Is the problem behavior maintained by accessing some event, or set of events, directly or through social mediation? Does such behavior serve to access that event every time or intermittently? Is there a reliable relation between the problem behavior and the presentation of this event? What is the specific object, activity, or event that the client is attempting to access through this behavior?

2. Are there other behaviors in the client’s repertoire that also can produce this desired event or set of events? Are they as efficient at producing the specific positive reinforcer as the problem behavior (see Horner & Day, 1991)? Is the problem behavior more likely to produce the desired event than these other behaviors? Which behavior produces the greatest density of specific reinforcement in terms of the event?

3. Does the problem behavior produce more than one positive reinforcer? What are the conditions under which it produces one reinforcer in contrast to another reinforcer? In other words, what are the different antecedent conditions in which the behavior may serve different purposes?

2 Functional Behavioral Assessment of Problem Behavior 51

The first question assesses the possibility that the behavior is maintained by access to a specific item or event, either directly or indirectly. In reviewing the information obtained, ask the following questions: What environmental changes occur as a result of the person’s behavior? Does the behavior serve to get something that was not available before the behavior occurred? Is it possible that the problem behavior has to occur for some duration, or at some level of occurrence, before it accesses the desired event or item?

The second question asks, Why does the client resort to this behavior over other behaviors to get the desired item/activity? Suppose the answer to Question 1 reveals that a child’s tantrum behavior of several minutes duration is effective in getting dad to let the child go outside after dinner. If tantrum behavior is adaptive, other behaviors are apparently less functional in that regard. Perhaps asking nicely to go outside is ignored or responded to in the following manner: “Not until you finish all your chores and homework.” Hence, the utility of an appropriate verbal request in getting outside in a short time frame is “zero.” Given that scenario, tantrum behavior may be a quicker manner of getting outside to play with friends than finishing all of one’s homework.

You should consider that some problem behaviors may produce different reinforcers under different conditions. Question 3 makes such inquiries during the interview process. For example, a baby cries when it wants to be picked up, get fed, get clothes changed, be coddled, and a host of other events. To assume that crying always means a food request from the baby would be a gross mistake and would result in many vain attempts to feed the infant when not hungry.

The three questions in Table 2.14 aim to uncover possible escape functions of problem behaviors. The questions are similar to the questions in Table 2.13, except the focus here is determining if the function of the problem behavior is primarily escape (or avoidance) of an aversive event. Negative reinforcement is probably inherent when the problem behavior reliably results in withdrawal or termination of the undesired event or activity. The target behavior should also be more successful in terminating that activity than other behaviors. Lastly, the target behavior occurs in the presence of an aversive event (or one that is about to be presented).

The questions from Tables 2.13 and 2.14 are aimed at uncovering the event or events responsible for the maintenance of the problem behavior. Please do not always assume that the behavior is maintained by the first event or “thing” one sees after the behavior occurs. Very often, it is not. You have to examine all the events that reliably occur after the behavior as well as all the events that are abruptly stopped or withdrawn. It is a lot like playing detective, and your hypothesis is a hunch about the factors responsible for the problem behavior.

A hypothetical example can aid in your understanding of the importance of good leading questions during a behavioral interview. Let us take the case of the 4-year-old boy who throws

TABLE 2.14 n QUESTIONS FOR ASCERTAINING AN ESCAPE FUNCTION

1. Is the problem behavior maintained by escaping (or in some cases completely avoiding) some event, directly or through social mediation? Does such behavior serve to escape that event every time, or on some intermittent schedule? Is there a reliable relation between the problem behavior and the termination or postponement of the aversive event(s)? What is the specific object, activity, or event that the client is attempting to escape through this behavior?

2. Are there other behaviors in the client’s repertoire that also can escape (or avoid) such aversive conditions and events? Are they as efficient at escaping the aversive conditions as the problem behavior (see Horner & Day, 1991)? Which behavior produces the greatest density of reinforcement upon its occurrence, given the presence of the aversive event (or its impending presentation)?

3. Does the problem behavior successfully escape most aversive conditions? Is the behavior successful at escaping many instructional conditions or requests? What are the presenting aversive conditions when such a behavior serves an escape function or purpose? Is there more than one event or activity in which the client uses these behaviors to escape?

52 Functional Behavioral Assessment, Diagnosis, and Treatment

toys as an illustration of examining possible scenarios in which he throws his toys and how that allows for a hypothesis about the function of the behavior (see Table 2.15).

Note that the questions are aimed at uncovering the function of the problem behavior, either as access or escape. Notice that only at the end do you ask the interviewee why he or she thinks the client does the behavior. Presenting this question at the end allows the interviewee to see that you are interested in a current environmental reason for the behavior. Asking the staff or parents that question first often leads to some explanation of factors that are far removed from the current social context (e.g., because of being autistic, comes from a broken home, is conduct-disordered, hates me). Such inferences and explanations do not help in conducting an FBA and should be examined only once the data from the client’s current social context is available.

The following is a hypothetical scenario of a behavioral interview with a parent (Mrs. M/Mom) who has presented the problem of her 4-year-old child throwing his toys. The hypothetical responses are provided along with the analysis of the answer, contained in parentheses, by the behavioral psychologist.

Dr. Cipani: Mrs. M., I would like to find out more about the circumstances when John throws his toys, so I will better understand this behavior problem. When John throws his toys, what do you do? What do you say to him?

Mom: I tell him he won’t get any more toys if he mistreats them. I sometimes put him in time out, but that does not seem to work.

Dr. Cipani: (I am not sure if either of those consequences, that is, warning him and time out, are followed through reliably enough for me to consider their possible role in toy throwing.) Mrs. M, do you pick him up when he throws his toys, possibly in an effort to redirect him?

Mom: Well, sometimes I do, but very often I have his almost 2-year-old sister in my arms. When I go to pick him up, and put her down, then she starts crying. It seems like I do not have enough arms.

TABLE 2.15 n �POSSIBLE PARENT INTERVIEW QUESTIONS FOR TOY­ THROWING BEHAVIOR

1. When he throws his toys, does he reliably get attention or physical contact from his parents? Is throwing toys better than other behaviors are at getting his parents’ attention? Do other people also give him attention in that manner when he throws his toys? If not, is the rate of toy throwing higher with his parents than when he is with other caregivers?

2. When he throws his toys, does somebody get him another toy or object? Is it conceivable that he throws the toy he is currently in possession of to play with another toy at that time?

3. Is there anything tangible (food, drink, etc.) that he gets from his parents or someone else when he throws his toys? Will he continue throwing the toys until someone brings him the desired food or drink item?

4. Does someone get hit with a toy when he throws it? Is it possible that he is aiming at someone in particular? If he does hit, for example, a child with the toy, what is that child’s reaction upon being hit? Does the child cry and become upset? What does he do when the child cries?

5. Where does the toy usually land? Does it usually hit a wall? Does it usually break? Does he like the sound it produces when it hits the wall? Does he appear to enjoy that result?

6. Does he throw toys when it is time to change from a play activity to another activity that he may deem as not fun? Does he throw toys when he is asked to put them away? Does he throw his toys when he is asked to do something? When he throws the toys under one of these conditions, does it usually postpone the impending activity or transition to another activity for some time?

7. Why do you think this child throws his toys?

2 Functional Behavioral Assessment of Problem Behavior 53

Dr. Cipani: (Aha! Maybe we are getting somewhere now. Possibly this child becomes jealous when his sister is getting attention and physical contact from his mother, thus setting up the motivational context for him to engage in behavior that results in mom picking him up. Let me follow that up with an analysis of the strength of more appropriate behaviors in getting mom’s arms.) Yes, Mrs. M., you do seem to have your hands full. Does John ever ask to be picked up when he is playing with his toys? Especially at times that it would be difficult because you have his sister in your arms?

Mom: Well sometimes he does, but you know I cannot oblige him when I have his sister in my arms. I am just not strong enough to hold both of them. He also whines sometimes when I do not pick him up. But I was told by experts on TV to ignore “whiney-type” behavior.

Dr. Cipani: (OK, it appears that John does resort to other behaviors to get picked up, but such are not as successful as toy throwing in getting his mom to pick him up. Let me test out the possibility of toy throwing serving a socially mediated escape function from a demand to put away his toys.) Does John throw his toys when he is asked to put them away?

Mom: Not usually. In some cases, I don’t even ask him to pick up his toys, if we need to go somewhere, I will do it with him later. However, he is often pretty good about putting away his toys, especially when I help him and we make it a fun activity, with his sister getting in the act, too.

Dr. Cipani: (It does not appear that such a demand is driving the toy throwing. In her answer, I keep seeing John’s desire for her attention when his sister is around, and the sister competing for it as well. Let me make sure that leaving the play time period is not a condition that sets off toy throwing.) Does John object to leaving the play area to go to another activity?

Mom: Sometimes, like when it is time to take a bath in the evening. He will cry and scream and throw a tantrum on the floor, particularly if the play period was kind of short. I think he hates to take a bath.

Dr. Cipani: Any toy throwing occurring before bath time, say over the last 2 weeks? Mom: No, just tantrum behavior usually. Dr. Cipani: (Well, it looks like toy throwing serves to get mom to pick him up on some

intermittent basis. Other behaviors are not as reliable in getting mom to pick him up when his sibling is competing for the same thing. However, tantrum behaviors appear to be the optimal selection when John wants to avoid taking a bath. Perhaps the A-B-C chart should be set up for recording behavior when he is playing with toys and to determine whether toy throwing is correlated with his sister being held and receiving attention from his mom at the time.) Thank you. You have been most helpful. I would like to suggest that we start examining John’s toy-throwing behavior by collecting what we call “baseline data” [explanation of such is offered].

Interview questions might also address the possible antecedent conditions that can act as EOs, as an alternative or supplement to the above strategy. Instead of focusing on what outcomes the defined target behavior produces, the interviewer would attempt to identify the EOs that would be relevant for access and/or escape functions. Functions exist only under specific EOs; hence, the discovery of EOs that reportedly create problems in behavior management with the client are of significant investigative utility. EOs that indicate significant problems can then promote further inquiry into what undesirable behaviors are effective in producing the desired outcome. This may also help to identify operant response classes in which a number of topographically dissimilar behaviors all produce the same or similar environmental outcomes (i.e., functions).

The Cipani School Behavioral Interview Form focuses interview questions on potential antecedent EOs that may produce sufficient states of deprivation or aversion that make

54 Functional Behavioral Assessment, Diagnosis, and Treatment

TABLE 2.16 n THE CIPANI EO SCHOOL BEHAVIORAL INTERVIEW FORM

Deprivation EOs Questions for attention function: Does the student have extreme difficulty (rating of 6 or better on 10­point scale) ______ and if so, does such a circumstancea (EO) occur either hourly (designate H next to item), daily (D), or weekly (W)?

• When the student requests or demands adult (i.e., instructional staff) attention and is told to wait?

• When the student desires attention and the adult is unavailable for such?

• When an adult withdraws attention from the student and/or attends to others (classmates, peers)?

• When peers or certain classmates are present (versus the absence of such behaviors when they are not present)?

Questions for tangible reinforcer function—consumable items (involving eating or drinking something): Does the student have extreme difficulty (rating of 6 or better on 10­point scale) ______ and if so, does such a circumstance (EO) occur either hourly (designate H next to item), daily (D), or weekly (W)?

• When the student requests or demands a desired consumable item and is told to wait?

• When the student desires a preferred consumable item and the item is temporarily unavailable (and/or is told “No”)?

• When the student desires a preferred consumable item and is given a different item (e.g., redirected)?

• When others (classmates, peers) get the consumable item and this student does not?

• When the student does not get enough of the consumable item (e.g., wanted two cookies and got only one, finished item and wanted more)?

Questions for tangible reinforcer function—preferred activities or events: Does the student have extreme difficulty (rating of 6 or better on 10­point scale) ______ and if so, does such a circumstance (EO) occur either hourly (designate H next to item), daily (D), or weekly (W)?

• When the student requests or demands a desired event or activity and is told to wait?

• When the student desires a preferred event or activity and such is temporarily unavailable (and/or is told “No”)?

• When the student desires a preferred activity or event and is directed to an alternate activity (redirected)?

• What others (peers) get the desired activity or event and this student does not?

• When the student does not get a sufficient amount of time with the desired activity (e.g., wanted a half hour of computer time and got only 10 minutes, activity ended and student told to transition to a less desired activity)?

(continued )

problem behaviors more likely. This Form is divided into two major parts: deprivation EOs (for access functions) and aversive EOs (for escape functions).

Deprivation EOs. Questions delineated in the top part of Table 2.16 would determine the individual’s ability (or lack thereof) to delay/postpone gratification of desired items, activities, or events (age-appropriate ability). There are two categories involved in this section: (a) attention functions (i.e., state of deprivation exists for attention) and (b) tangible reinforcers (i.e., state of deprivation exists with respect to certain items or activities and events). The interviewee would identify what antecedent circumstances result in undesirable responses or reactions from the individual.

2 Functional Behavioral Assessment of Problem Behavior 55

TABLE 2.16 n THE CIPANI EO SCHOOL BEHAVIORAL INTERVIEW FORM (continued )

Aversive EOs Questions for unpleasant social situations function: Does the student have extreme difficulty (rating of 6 or better on 10­point scale) ______ and if so, does such a circumstance (EO) occur either hourly (designate H next to item), daily (D), or weekly (W)?

• When the student is presented with any social or task demand (i.e., problems in compliance to simple adult/teacher instructions)?

• When the student is in circumstances that involve following the rules of a game or play activity?

• When the student is criticized or corrected during instructional task or chore?

• When the student receives social disapproval from an instructional staff person or peer (for behavior, manner of dress, way of talking, etc.)?

• When the student receives a negative consequence for behavior or is threatened/warned with one (e.g., is told he or she will lose some free time after lunch for some behavior)?

• When the student is interacting with certain peers or instructional staff members?

• When the student is in social situations with too many people?

• When the student is in social situations with novel people?

• When the student is in social situations with a member(s) of the opposite gender?

• When the student is in an argument with a peer/friend/other?

• When the student is in novel social situations or settings?

Questions for relatively lengthy tasks, instructional sessions, or chores function: Does the student have extreme difficulty (rating of 6 or better on 10­point scale) ______ and if so, does such a circumstance (EO) occur either hourly (designate H next to item), daily (D), or weekly (W)?

• When the student is presented with instruction, seatwork, or an instructional activity that is relatively lengthy (e.g., 1 hour in length when the current duration for active engagement is 10 minutes) for that student?

• When the student is presented with a nonacademic task that is relatively lengthy (e.g., 1 hour in length when the current duration for active engagement is 10 minutes) for that student?

Questions for relatively difficult tasks, instructions, chores function: Does the student have extreme difficulty (rating of 6 or better on 10­point scale) ______ and if so, does such a circumstance (EO) occur either hourly (designate H next to item), daily (D), or weekly (W)?

• When the student is presented with instruction, seatwork, or an instructional activity that is relatively difficult (lacks prerequisites or skill in its entirety) for that student?

• When the student is presented with a nonacademic task that is relatively difficult (lacks prerequisites or skill in its entirety) for that student?

EO, establishing operation.

Source: Taken with permission from Cipani EO School Behavioral Interview Form; see Appendix A). aCircumstance refers to the particular EO, i.e., how often would this student encounter the presenting condition.

With each question, the interviewer would identify the degree to which the designated antecedent condition creates an EO involving undesirable behaviors becoming functional. I recommend the use of a rating scale of 1 (no difficulty handling the circumstance representing the specific EO) to 10 (major problems with undesirable severe problem behaviors when this EO is present) for each question. If the deprivation state EO is rated at or above a 6 score, the interviewee could inquire if such a circumstance occurs either hourly (designate H), daily (D), or weekly (W) on the data sheet.

56 Functional Behavioral Assessment, Diagnosis, and Treatment

ASSIGNMENT

After reviewing the narrated PowerPoint lecture entitled, “How to Use the Cipani EO School Behavioral Interview Form,” write a paper that discusses the follow- ing points:

1. What EOs were selected for behavioral interview and why? Describe those in detail.

2. What behaviors were reported subsequent to the presented EOs? Did such behaviors produce the AO immediately?

3. How did such behaviors produce the conditions necessary for access to the valued item? Why was problem behavior more effective in getting the desired item that earning tokens for various behaviors?

4. What was the mistake made by staff that made the problem behaviors endemic to the EO conditions?

The behavioral interview proceeds by posing each question to a significant person in the student’s life and asking if such a circumstance creates difficulty for the student. If the answer is in the affirmative, the significant other is asked to rate the degree of difficulty. Ratings above 6 might be indicative of an EO for problem behavior. The interviewer can ask the significant other to describe the forms of undesirable behaviors that occur to such a deprivation EO in detail. Such information can guide further inquiry and possibly experimental test methods for such a function under the deprivation EO. For example, using one of the items below, the interviewer would ask the person the following: Does the client have significant difficulty when requesting or demanding a desired consumable item and is told to wait? If the answer is “yes,” the person would then be asked to rate the level of difficulty. If it is rated above a score of 6, the person could then ask to describe what the person does in response to being asked to wait (i.e., delineate the unacceptable behaviors that occur in that context). Finally, to get an idea of the level of the problem behavior, the person would be asked if such a condition occurs hourly, daily, or weekly.

To obtain further interview information if the problem behaviors identified as occurring in the target context are functional under an identified EO, ask, What do you have to do to get the student to stop that behavior? The production of the desired reinforcer in sufficient magnitude should serve as an AO, making the problem behavior and its hypothesized function of little utility, when the EO is weak to nonexistent. This information provides more evidence of the probable function of the problem behavior(s).

Aversive EOs. The same information is desired in the bottom part of Table 2.16 for escape functions except the focus is on circumstances that assess whether the individual tolerates aversive events and stimuli (age-appropriate ability). Escape functions examine three areas of possible aversive states that might constitute an EO: (a) relatively unpleasant social situations, (b) relatively lengthy tasks, instructional sessions, or chores, and (c) relatively difficulty tasks, instructional sessions, or chores. If such conditions produce a sufficient aversive condition for the student, probe further to discern what behavior(s) are probable under such EOs. As with access functions you would also ask, “What do you have to do to get the student to stop that behavior(s)?” If you are going to use the following information from Table 2.16 in a report, with our permission, please reference this text as a citation (i.e., The Cipani EO School Behavioral Interview Form taken with permission from Cipani, 2018, Functional Behavioral Assessment, Diagnosis, and Treatment: A Complete System for Education and Mental Health Settings, pp. 311–313). Appendix A provides the data sheets, with permission to the owner of this text to copy and use.

www.springerpub.com/fbadt

How to Use The Cipani EO School Behavioral Interview Form Narrated Presentation

If several sources of information about the function of behavior have been collected, it is necessary to synthesize such information into a coherent, plausible hypothesis. The four questions in Table 2.17 will be used once all the assessment information included in this chapter has been collected to determine the function of the problem behavior. Question 1

2 Functional Behavioral Assessment of Problem Behavior 57

attempts to determine if a reliable contingency exists between the problem behavior and the hypothesized maintaining contingency. In ascertaining this, one needs to concurrently address whether such a behavior is more efficient and effective at getting the desired event (or escaping the aversive event) than other behaviors (see Question 2). If a client is allowed to get food from the refrigerator when he or she wants, then other problem behaviors become less probable when food access is the EO. Therefore, diagnosing the problem behavior in terms of such a contingency would not make sense. In contrast, when other behaviors, such as getting your own food or asking nicely, are effectively impeded, and therefore not reinforced, then the conditions are ripe for problem behavior to become instrumental in getting food when relatively hungry.

Questions 3 and 4 address the operative motivating condition (EO), given the hypothesized maintaining contingency. For example, if a behavior is functional in getting food, then its occurrence would be in the absence of having food, or possibly as the individual has finished all the food (and wants more). In other words, in order for a behavior to be maintained because it produces a specific reinforcer, such an event must be in a relative deprivation at the time of the response occurrence. Concurrently, once food is accessed, does the problem behavior desist once access to the supposed reinforcer took place? Let us say that being picked up by a child’s parents is hypothesized as the factor maintaining his or her crying. If the child is picked up and continues to cry, does it make sense that the child cried to get picked up? It would appear that crying had a different function at that time.

Question 4 addresses the same issue as Question 3 except that with escape functions, the behavior occurs when the aversive event is present (or impending in the case of an avoidance function). Once the event is removed or terminated does the behavior stop, given that escape has resulted?

TABLE 2.17 n QUESTIONS TO ZERO IN ON FUNCTION

1. Does the problem behavior appear to reliably produce the hypothesized contingency?

2. Is the problem behavior more efficient and effective at producing such a contingency, in contrast to other behaviors that may (or may not) produce the same contingency?

3. In the case of an access function, does the behavior usually occur in the absence of the desired event or object (deprivation EO)? Does the behavior stop once the desired outcome is procured?

4. In the case of an escape function, does the behavior usually occur in the presence (or advent) of the aversive, undesired event or object (aversive EO)? Does the behavior stop once the desired outcome is procured?

DISCUSSION QUESTION 2C Explain how a client’s spitting behavior can be maintained by two different reinforcement contingencies. (Hint: think of people who chew tobacco for one function.)

A-B-C Descriptive Analysis Professionals are at a loss when treating children or clients with problem behavior. Professional involvement in the child’s daily life is minimal, if at all. Rather, teachers, parents, staff persons in facilities, and care providers are people who can be intimately familiar with the circumstances involving the client and problem behavior. In a perfect world, such direct line personnel would be sufficiently trained in applied behavior analysis to be able to analyze behavioral function and the antecedent conditions. They would simply come to the professional in the end and say,

58 Functional Behavioral Assessment, Diagnosis, and Treatment

Bobby’s spitting behavior on the playground is significantly more likely when he is asked to share the tetherball or it is time for another child to have the tetherball. Further, it appears that such behavior seems to be reinforced by the playground aide. This aide will make the other children wait longer for their turn when he spits on them. She tells them they must be patient because Bobby is emotionally immature. We believe this is a mistake and that such a contingency is actually exacerbating the probability of Bobby spitting on other children when it is time for him to give up the tetherball. As a result, we think the following treatment program addresses this function by removing the tetherball for at least a 4-minute period when he spits. In addition, if he waits at least 2 minutes without spitting, he will then be allowed to play. This interval will then be progressively altered until it reaches the average wait time for tetherball. If you write up that plan we feel it could probably work.

Sound nice? Yes! However, in the real world you are more likely to get the following analysis of Bobby’s behavior from direct line personnel and parents: “Bobby does it because he is ADHD.” However, such direct line personnel can be very helpful if they are taught to collect data on behavior in real time.

Having personnel describe the conditions surrounding the behavior has been termed the A-B-C descriptive analysis method (Bijou, Peterson, & Ault, 1968; Lalli, Browder, Mace, & Brown, 1993). In an A-B-C descriptive analysis system, direct line personnel observe the client. There are usually three columns for the data collection: the first column is reserved for a description of the antecedent conditions, the client’s behavior is delineated in the middle column, and the final column provides a description of the consequences of the behavior.

In the hypothetical example shown in Table 2.18, the targeted behavior for observation is a particular child’s aggression (i.e., hitting another child in the elementary kindergarten class). The teacher identifies the antecedent context as story time. After the first hitting incident occurred, the teacher noted that the child was removed from the story group (consequence column). Note that the termination of some group activity seems to be the commonality between these two descriptive analyses of the incidents. If this result “holds-up” with other recorded incidents, then a socially mediated escape function might be entertained for the function of this behavior, given certain group activities.

The A-B-C method differs from behavioral interviewing in that it requires teachers, facility staff, or parents to collect data in real time rather than recollecting past events. It may be more indicative (reliable) of actual events in that it is being collected right at the time when the behavior occurs.

How does one utilize such data? You will want to review all the incidents of the target problem behavior and look for reliable relations between behavior and its consequences. Commonalties may show patterns across time between the problem behavior and certain consequences. For example, with the child in Table 2.18, the removal almost always occurs when the child hits another child. Further, this behavior is more common during story time (when the child gets bored with the story and wants to escape) or during group time (probably wishing to terminate participation). If other behaviors are not successful in producing escape

TABLE 2.18 n EXAMPLE OF A­B­C CHART

Antecedent (A) Behavior (B) Consequences (C) of Behavior

9:20; During story time, 15 minutes into the story

Hit peer Removed him from story time

10:30; During group music time

Hit another peer Told to stop, peer hit back, removed both of them

2 Functional Behavioral Assessment of Problem Behavior 59

or avoidance of the undesired activity, then hitting another child to escape or avoid these activities becomes a more plausible function.

Problems With Descriptive A-B-C Charting Methods Unfortunately, there are many problems with A-B-C data collection methods as they have been traditionally used, which we believe preclude their use to derive the function(s) of behavior. Perhaps two of the biggest problems in determining function from such methods are: (a) the insufficient description of the antecedent condition (A column) by the user and (b) the tendency to view almost all behaviors as the result of social attention (D. Wilder, personal communication, September 1, 2009). An analysis of each of these problems follows.

Insufficient Description of Antecedent Variables. The antecedent condition contains two variables: EOs and discriminative stimuli. Unfortunately, behavioral descriptions of the antecedent condition often lack a depiction of the EO. Here is why. When a behavior serves an escape function, the presence (or presentation) of the aversive condition (i.e., the aversive EO) is somewhat easy to spot. With aversive EOs, the person who is filling out the A-B-C chart describes what someone is doing or saying to the client in column A (preceding the behavior description). By specifying this observable phenomenon, the antecedent condition can potentially identify the specific aversive event being presented. Hence, the analysis of this hypothesized aversive event’s value-altering effect on the reinforcer might be gleaned from the written record. Also if the user specified the person (or persons) involved in the presentation of these events, discriminative stimuli can be identified.

However, with problem behaviors serving an access function, a relative state of deprivation will produce the value-altering effect on the potential reinforcer. Unlike the presentation of a task or social situation that serves an aversive EO function, one cannot usually see a state of deprivation. Therefore, to record what is observable prior to the behavior may be tangential and/or irrelevant to the “true” operating EO. Hence, a naïve user does not usually delineate the deprivation condition in an A-B-C chart because this would require an adequate knowledge of the role of motivational variables. Further, they would note the absence of an item or activity (i.e., not in client’s possession at that time).

Subsequently, the information provided on the A-B-C charting form can lead to a false interpretation about the “true” motivating condition. For example, a young boy skips lunch and later that day attends his brother’s baseball game. He starts whining about wanting a hot dog and engages in a number of undesirable behaviors. Of course the presence of his parents is discriminative for such behaviors, but neither they nor the baseball context serve as the EO. The EO condition was dictated by what happened earlier, that is, he skipped lunch. It was the food deprivation that produced the value-altering effect of the potential reinforcer and the functional relationship between behavior and a specific reinforcer. The value of food was established by being deprived of food (EO); the availability of food (SD) was indicated by the parents being present and food being available at the ball park.

All too often, written FBAs present interpretations about a problems behavior’s function that designate the antecedent to be some aspect of the context when the behavior occurs. You may see reports that indicate that the behavior is highly likely under a variety of context conditions, for example, when there are bright lights in the classroom, when there are too many chairs, not enough chairs, and so forth. But such events may correlate only with a given behavioral incident. It is a mistake to assume that such constitute aversive EOs (which drive a function) simply because they were present at the time of the problem incident. These interpretations are the unfortunate consequence of the data system missing the analysis of the EO for all access functions as one of relative state of deprivation. The next preferred FBA method, trigger analysis with behavioral description, corrects that omission.

A related issue with the lack of specifying an EO is that the individual entries often contain different EOs. For example, the hypothetical chart below shows three different entries (Table 2.19).

In the first entry, a problem behavior occurred in response to a teacher request (aversive EO). Note that the consequence that is entered really has nothing to do with abolishing the

60 Functional Behavioral Assessment, Diagnosis, and Treatment

EO. So while it certainly follows the behavior, it does not entail the “maintaining contingency.” Also note that there are no further entries on this existing aversive EO. What happened to that condition? Did the student open his book to page 62 and go about doing his work? Or did something else happen that provided the escape from such a request? Was there eventual compliance, or not? That would have been useful information.

The second entry appears to have nothing to do with the original EO. Rather it appears to present an additional, new EO into the environment. This unpleasant situation is an example of another aversive EO, but different from the teacher demand in that it originates from a peer. Again, the C column does not adequately follow this up. Jose’s response to the peer occurs to this new EO, and the critical information is the effect it had on the peer who originated the “disrespectful look,” and possibly the reaction of the fellow classmates to this encounter. Reporting what the teacher said is irrelevant in terms of this function. Finally, the third entry is unrelated to the above two; one could surmise that such a behavior is intended to effect the timing of being excused for lunch recess. Again, there is no follow-up to the presence of this presumed EO and the ineffectiveness of the listed behavior to abolish that. Perhaps, a minute later, another pleading by this child resulted in his or her being dismissed for the cafeteria early. Only if this information is captured would the “true” function of the verbal behavior possibly be revealed.

Unfortunately, this diverse set of behavioral descriptions is often synthesized by users into one function. A naïve professional would attempt to integrate the three entries in Table 2.19 into one function. Yet it is more plausible that each of the three entries involves a different EO; hence, a different function. For this reason, we are recommending that the trigger analysis with behavioral description charting system be utilized (presented in following section of this chapter).

Over-Selection of Adult Attention as Function. Another problem with the traditional A-B-C descriptive analysis is the over-selection of social attention as the maintaining contingency. Very often you hear personnel indicate that the behavior is maintained by attention, and they point to the A-B-C record to show that attention (in some form) always follows the behavior. This interpretation regarding behavioral function is again an unfortunate outcome of the manner in which descriptive analyses collect information. While attention, either in the form of a verbal statement, physical proximity, or physical contact, will often follow the problem behavior, it may be tangential to the behavioral function that is operable under a specific EO. The charting in Table 2.19 illustrates such a problem. The reviewer of this data would probably conclude that the teacher’s attention is the function of problem behavior (incorrectly).

It is more often the case that someone’s attention may be coincidental to the actual function, which may be access to a tangible reinforcer, escape from an unpleasant social situation, escape from task demands, and so forth. However, because the adult mediates such access or escape from the aversive stimuli, his or her attention/proximity

TABLE 2.19 n A­B­C CHART

Antecedent Behavior Consequence

10:10 Teacher said, “Take out your book and work on page 62.”

“I don’t want to!” Teacher said, “Now José, why are you being so difficult today?”

10:12 Another student looks at José (in a disparaging manner).

“Hey quit looking at me that way!”(with facial grimace).

“Alright, both of you need to stop bothering each other.”

11:15 Before lunch

“I am hungry. I want to eat right now!”

“You will have to wait.”

2 Functional Behavioral Assessment of Problem Behavior 61

is inherently involved, but is misconstrued as having a primary causative role! In many cases, the role of an adult’s presence in socially mediated behavior is one of the delivery of the desired event, and one’s attention is a necessary condition but not the maintaining contingency. Only for problem behaviors that produce their effects directly (i.e., direct access and direct escape problems), would people often not be involved subsequent to the behavior! Otherwise, an adult’s presence, attention, or proximity is endemic to functions involving social mediation. Again, an understanding of the EO and its influence in establishing the value of a particular outcome in access and escape functions is missing in these analyses.

The upshot: one cannot simply examine the social event that occurs right after the problem behavior and infer that such an event serves as the maintaining contingency. If one does, the hypothesis about the possible function of behavior will often be attention (verbal and/or physical), which will often be an inaccurate conjecture.

Trigger Analysis With Behavioral Description The utility of a trigger analysis (A. Rolider, 2003; A. Rolider & Axelrod, 2000) as a behavioral assessment method is the ability to collect data on infrequent target problem behaviors. It requires the presentation of the hypothesized EO and SD in the real-life context, with the person(s) who normally are involved with the client. The occurrence (or absence) of the target problem behavior is then noted (if a dangerous or extremely disruptive behavior is the target problem, use a precursor behavior to end the trial, instead of the dangerous target behavior). As delineated in a prior section of this chapter, you can then compute the percentage of times the target behavior occurs. These quantitative data are derived with the ratio of occurrences of target behavior over the total number of times the EO/SD condition was presented. For further information on the specific procedural requirements for conducting a trigger analysis with a variety of access and escape functions, the reader is enjoined to consult Cipani and Cipani’s (2017) Diagnostic Manual.

But if we add a slight variation to the data collection, a trigger analysis can also provide qualitative information about behavioral function. The procedural requirements for conducting this method remain the same as previously described. With the behavioral description component added to the trigger analysis, a running description of behaviors that occur subsequent to the EO presentation is delineated by the user. Once a behavior produces the abolishment of the EO, the trial ends. Within a given discrete trial (begins with EO and ends with AO), information regarding the effectiveness of various behaviors that occurred can be gleaned, including the behavior that eventually produced the functional reinforcer.

This is how the data will be collected on a charting system with three columns. The A column would be a delineation of both the EO condition and the discriminative stimuli (people) for the behaviors. This EO entry in the first column would remain the same for the descriptive record of the various behaviors that occur subsequent to the EO presentation. Behavioral descriptions are written in the second column and continue until the EO condition is abolished (AO), which is delineated in the third column. All behavioral entries in column B would be described and possibly “time-stamped.” For example, descriptions of what the client does are listed vertically in chronological order. Information that indicates whether the EO condition was abolished (or not) is entered in the third column (i.e., maintaining contingency that is related to the EO for that trial). One can then examine the various behaviors that occur under the delineated EO and their effectiveness (or lack thereof) in attaining the functional reinforcer. The third column requires only that the user provide an entry indicating whether the hypothesized functional reinforcer is delivered. Note that there are major differences in how the user fills out the first and third columns in comparison to the A-B-C descriptive chart mentioned earlier in this chapter. These changes correct some of the faults of such a descriptive data collection method.

Here is an example of the data collection for a given trial. Let us say we have a young girl in a mainstream class who does not like to read aloud when it is her turn. Therefore, the value of terminating the oral reading task is initially established whenever her oral reading

62 Functional Behavioral Assessment, Diagnosis, and Treatment

group comes up to the teacher’s desk. The value of escape is subsequently increased when it gets closer to her turn to read. The teacher normally avoids having this student read aloud, so the consultant asks if the teacher can induce such a condition, to determine if such requests to “read aloud” are the “driving force” for the problem behavior. With consent obtained from school personnel and parents, the teacher agrees.

The teacher would present the group oral reading format as usual. Instead of avoiding this student, the teacher now calls on her to read aloud. The data collection ensues at that point. The teacher might also capriciously request oral reading from this student at other unpredictable times to determine if the behavior can be “provoked” by this potential aversive EO. A simple analysis of whether the behavior occurred or not would reveal the number of times the problem behavior occurred over the number of opportunities. For example, over a 2-week period, the number of times the student engages in the identified target behavior (some form of nonresponsiveness when called upon) was 8/9.

Table 2.20 illustrates a hypothetical data collection of a trigger analysis with behavioral description and the information it would provide. Note in column B, there are several behavioral descriptions, along with the time the episode occurred. What is fruitful with this method of charting is each behavioral episode (description) can now be evaluated against its ability to alter the individual’s antecedent motivating condition, by examining the third column. With the behavioral description at 8:56 a.m., one can see that the aversive condition, having to read aloud, is avoided effectively. If future data collection using this charting shows that such similar nonresponsive and inappropriate behaviors are effective in terminating or avoiding reading aloud, one has better evidence about the function of these types of behaviors.

The argument regarding the hypothesized function is strengthened by the use of the descriptive qualitative data with the trigger analysis. One can observe the differential effectiveness of varied behaviors under column B on the relevant function. When determining function it is important to note two phenomena. First, one should find that there is a reliable relation under an EO between the problem behavior(s) and a maintaining contingency. Second, the inefficiency of other behaviors to produce the desired outcome relative to the target behavior would also be apparent. Following is a real-life case that illustrates the analysis of behavioral function of aggression with respect to the initial EO involving the value of riding on tricycles during free play activities.

Head Start and the Tricycles I was a behavioral consultant to Head Start in the early 1990s. I provided specific strategies to deal with problem behaviors of the children attending the particular site. Often the referral was for a child who was aggressive (overwhelmingly boys). One of the referrals for aggression was a boy who exhibited such behavior during outside playtime. The catalyst for such behavior revolved around the desire of many children to ride one of the three tricycles. If six children want three tricycles, all at once, a conflict arises. The children argued and pushed each other away from the bikes in order to establish themselves as the bike riders. Once a child landed in the seat, she or he usually went unchallenged (kind of like King of the Mountain). As you could guess, my client was quite good at getting the bike and keeping it.

TABLE 2.20 n BEHAVIORAL DESCRIPTION

Antecedent (EO) Behavioral Description (B) Contingency (AO)

Oral reading group with 3rd­grade teacher (Aversive EO)

Gets to group and opens book (8:50 a.m.)

Not effective in avoiding advent of task demand

When called on to read, stammers, then puts head under the table (8:56)

Effective, teacher moved to next person to read aloud and excused student from group

AO, abolishing operation; EO, establishing operation.

2 Functional Behavioral Assessment of Problem Behavior 63

As is evident, aggression in this context is a behavior that produces access to the tricycle and maintains such engagement with the tricycle. In comparison to other behaviors, aggression, when performed adeptly, is far more effective and efficient than other behaviors, such as pleading, whining, or crying. But what was very telling was how the teachers reacted to aggression. When a child complained about being “bullied” by another child, they did not resolve such disputes. Instead, the petitioner (child) was told to go back and work things out for him- or herself. I asked one of the teachers why none of the staff mediated the disputes with the bike (until someone was hit). She remarked, “Our philosophy here is that we want the children to learn to work out their problems on their own. If we solve their interpersonal squabbles and problems, they will never learn to develop self-control and personal responsibility to themselves and their fellow human beings.” As you can see, such a policy would make verbal threats and stealth incidents of aggression become functional in getting the trike. An analysis of the contextual factors point to aggressive behavior serving a socially mediated access (SMA) function; getting the trike (see Table 2.21).

What would a trigger analysis with descriptive assessment chart look like? While this was not done, the hypothetical illustration in Table 2.22 would be plausible given the

TABLE 2.21 n QUESTIONS TO CONSIDER

1. Is the existing motivational condition for that child one of relative deprivation of that item or activity? Answer: Yes. Three tricycles and many children desiring such sets up the EO for such an activity. In point of fact, if there were 10 tricycles, with no need to wait for a tricycle to become available, the EO would be low because the desired event would be freely available.

2. Is there a reliable, somewhat frequent relation, between the child’s problem behavior and accessing certain items or activities? What is the form of the behavior and what items or activities are produced? Answer: Yes. Aggression against other children in a profound manner resulted in this child getting the tricycle on a regular basis (or any other item/toy he or she wanted).

3. Is the problem behavior more likely to produce the tangible reinforcer than acceptable appropriate behaviors? Answer: Yes. Particularly in light of the failure of the social environment to selectively reinforce a more appropriate behavior by controlling who initially get the tricycles and for how long they have access to the tricycles.

EO, establishing operation.

TABLE 2.22 n TRIGGER ANALYSIS WITH BEHAVIORAL DESCRIPTION

Antecedent (EO) Behavior (B) Contingency (AO) Future Probability of Behavior Under EO

Desire to ride one of three tricycles; during outside play time commenced

Asks if he can get on tricycle

Not told anything, not effective in getting tricycle

Less likely

Says he is going to tell the teacher

Verbal statement ignored. Not effective, EO still present

Less likely

Pushes peer off tricycle, peer who was pushed off cries and goes to another area of the play area

Effective immediately, he rides tricycle and is not challenged by another, deprivation state abolished

More likely

AO, abolishing operation; EO, establishing operation.

64 Functional Behavioral Assessment, Diagnosis, and Treatment

information from Table 2.21. In this case, the failure of the social environment to mediate other “more appropriate” behaviors to procure one of the tricycles was a major factor in the continued utility of aggressive behavior. Intervention would have to significantly alter the manner in which the teachers intervened in this context (i.e., a failure to intervene). Aggression had to be made less functional, while more appropriate behavior had to become functional in getting the tricycle. This was accomplished by designating the following contingency for aggression: removal from the play area for a brief time and loss of any tricycle time that recess period. But an additional component is needed to strengthen a more acceptable way of getting a tricycle. I decided to make complaining to the teacher and making the children involved in the squabble accept a “plea deal from the teacher” produce a functional result. The plea deal meant the parties involved in the complaint would all get a shorter allotment of time on the tricycle, but they would each be allotted some time. The teacher would announce the following: “You get the tricycle for 3 minutes, then she gets it for 3 minutes,” and so forth.

With this approach, aggressive behavior dropped dramatically, including the aggressive behavior of the child referred to me. The removal of the opportunity to ride the tricycle whenever a child aggressed made such a behavior unproductive in this context. The teachers remarked that the children were now bringing their complaints surrounding toys and bikes to them frequently. These functional treatment contingencies produced a more acceptable way for children to work out their “impulsive” behavior. What was also an interesting finding in this program was that many of the children who needed the tricycle right away learned one of two things: how to wait, or how to find something else interesting to play with that was not in as great a demand as the bikes. Can children actually learn to refrain from aggression? This finding does not settle with the old adage, “boys will be boys.” Perhaps, we adults have a lot more to do with aggression than scholars portend.

A Better A-B-C Descriptive Chart To reiterate what was stated previously in this chapter, contriving a motivational condition may not be feasible, or you may not receive authorization to conduct such (via informed consent). You can use the above method of charting behavior without the EO inducement, by noting a naturally occurring deprivation or aversive EO for the particular client or student. It would be necessary to gather some interview information via the Cipani EO Behavioral Interview Form (see Appendix A) to deduce potential deprivation and/or aversive EOs before collecting data.

For aversive EOs, their presentation would be apparent and you delineate such an aversive EO in column A. You would write down each behavioral episode (descriptions) following the presentation of the aversive event, and whether such a behavioral episode was effective (or not) in abolishing the EO in the last column. Continue the data recording until the hypothesized EO is abolished. With respect to deprivation EOs, you may have to watch for initial attempts to access some item, activity, via some request, which is subsequently denied. For example, you observe the target student ask for computer time and the request is denied. You would begin data collection with this deprivation EO and observe if this person’s behavior escalates to levels of disruption that seem to characterize the problem referred. Of course begin charting the behavioral descriptions immediately after observing the denial of access to the activity.

The following hypothetical example illustrates the A-B-C data collection and analysis, with the self-injurious behavior (SIB) of a hypothetical child with disabilities during speech therapy. In this hypothetical assessment, it was not necessary to contrive the EO; all that was necessary was to study the behavior under this naturally occurring context in the speech therapy sessions.

In Table 2.23, the presentation of a language task that requires speaking in sentences creates the aversive condition for this hypothetical child with severe developmental disabilities. The therapist becomes a discriminative stimulus for certain behaviors that are more efficient than others, at least temporarily removing or postponing this activity. Note that the first behavior occurring at 9:28 a.m., one of saying “I, not,” did not produce escape. Neither did exhibiting the target appropriate language skill (see third row) result

2 Functional Behavioral Assessment of Problem Behavior 65

Simulation Exercise: Trigger Analysis of SMA Functions

With another person (role respondent), identify some item that person possesses and indicate to the class that such is a desired item (one whose loss is stipulated as cre- ating an EO). Prior to the actual display of the interaction, decide which one of sev- eral behaviors will result in giving the item back to the role respondent (unknown to class-observers). The observers should develop the data sheet to reflect the three columns (the EO or Antecedent column), the behavioral description column, and the AO (or maintaining contingency in the third column), as depicted in this text. You and the role-play respondent then perform the simulation. You remove the item and the role respondent engages in a number of behaviors (include appropriate and inappropriate), with one of them resulting in his or her getting the item back. Make sure you provide enough time between each behavior so that the observers can write each behavioral episode on their data sheet (5–10 seconds should be sufficient). When the functional reinforcer is delivered, the observers indicate such on their data sheets in the third col- umn. Then compare what behaviors were observed that did not result in access to the item versus the one that did (last entry). Make sure that you provide the item across a diverse type of behaviors, including vocal (e.g., “give that back or I will scream”) and nonvocal (e.g., volunteer stomps on floor) across multiple demonstrations. Repeat the simulation demonstrations multiple times to obtain practice effect.

in the termination of the task! As a result of not allowing such a vocal performance to terminate this aversive instructional activity, shortly thereafter, she slaps herself. Note that this incident occurs 7 minutes into the session when the aversive nature of the context has increased. Contingent upon this slap to the face, the therapist changes the instructional format. The therapist indicates that the child can just say one-word responses, if she will not hit herself. With such a change in response requirements, the aversive EO is abated, and self-injury stops. But if the full sentence requirement is reinstated again, the same aversive EO conditions are operable. If the same function exists for slapping oneself, relative to other behaviors, this behavior is likely.

Let us take the same instructional context and present a trigger analysis for another student whose self-injury is hypothesized to function as access to a tangible reinforcer. A hypothetical 6-year-old student with autism goes to speech class two times a week and

TABLE 2.23 n ANALYSIS OF LANGUAGE TASK

Antecedent (EO) Behavior (B) Contingency (AO)

Presentation of language task with speech pathologist, requiring full sentences

“I, not” and turning her head away from person (9:28 a.m.)

Not effective (speech pathologist chides her to try, re­presents task)

Cries (9:30) Not effective, continues with task

Said a full sentence, “I see a dog.” to picture card (9:32)

Not effective, praised for full sentence and next item presented (i.e., requiring a full sentence)

Slaps self (9:35) Effective immediately, therapist says “let’s try something else” and goes outside to play with the girl

AO, abolishing operation; EO, establishing operation.

66 Functional Behavioral Assessment, Diagnosis, and Treatment

Simulation Exercise: Trigger Analysis of SME Functions

With another person, identify some action that would create a state of aversion for that person (one whose presence is stipulated as creating an EO for such). For example, you can grab an arm/hand, begin chattering, stand close, or present the person with an assumed difficult academic task (just make sure such behavior does not create a “real” aversive event to the person—no lawsuits wanted). Prior to the actual display of the interaction, decide which one of several behaviors will result in you terminating the “aversive” action (without the class observers being aware of the selection, only the role respondent). The observers should develop the data sheets to reflect the three columns: (a) the EO or antecedent column, (b) the behavioral description or B column, and (c) the C column containing the AO or maintaining contingency (as depicted in text). You and the role-play respondent then perform the simulation, allowing enough time between behaviors for the observers to write down their descriptions. When the functional reinforcer is delivered (i.e., your aversive action is terminated), the observ- ers indicate such on their data sheets. Then compare what behaviors were observed that did not result in access to the item versus the one that did (last entry). Make sure that you provide escape from the aversive event across a diverse type of behaviors, including vocal (e.g., “give that back or I will scream”) and nonvocal (e.g., kicking floor) across the multiple demonstrations. Repeat the simulation demonstrations several times to obtain practice effect.

TABLE 2.24 n TRIGGER ANALYSIS

Antecedent (EO) Behavior (B) Contingency (AO)

Access to favored toy blocked temporarily

“I want” Therapist says “good asking” but not effective in getting the toy

Cries Not effective, continues with task and is told to wait for the toy until some work is done

Said a full sentence, “I see a dog” to picture card

Not effective, praised for full sentence and next item presented

Slaps self (four times) Effective after fourth slap, “OK, you can have the toy to hold if you will work as well.”

AO, abolishing operation; EO, establishing operation.

at varying times is given a favored toy. Sometimes the student is given the toy right at the outset of the session, sometimes only after the session has ensued. In this case, it may be necessary to induce the EO. Hence, instead of giving this student the toy right away, the speech therapist will hide the toy for a period of time and begin the session. This hypothesized deprivation EO could then be induced several times in the therapy session by taking the favored toy away after short periods of access. The running description of this hypothesized function is given in Table 2.24.

In summary, a trigger analysis with behavioral description allows for an analysis of the effect of many problem behaviors displayed on the diminution of the operable EO (see Cipani & Cipani, 2017 for more examples of the above charting system). In the case of access behaviors, a behavioral description of various incidents when deprivation is in place identifies the efficiency and effectiveness (or lack thereof) of displayed behaviors to abate the EO. In the case of escape behaviors, each behavior’s ability to terminate the aversive event can be evaluated.

2 Functional Behavioral Assessment of Problem Behavior 67

Scatter Plot You receive a referral for a client who runs out of the residential unit once a day, pretty much every day. You ask the staff (mistakenly), “Why do you think he does that?” The reply provides little information (and verifies why you should never ask that question first): “He’s just being Bobby. You know he is autistic!”

Like me, you are probably still wondering why Bobby does this only one time each day. Is there a particular time this daily event happens? If the recording of this behavior specified the time it occurred, such information might be available. Suppose you see that this behavior occurs around 2:30 p.m. every day. Now your interest is really peaked! What happens at 2:30 that sets the occasion for Bobby to run out of the unit? The answer: shift change. With shift change comes new people coming in from the parking lot. But why does Bobby run out of the parking lot during shift change? The answer: to see one car in particular. You now know the function of this behavior.

Not all referrals will be as simple as this illustration. Often the behavior occurs several times across the day, and it is not easy to pick out what “trigger event” seems to occasion the exhibition of the problem behavior. The scatter plot (Touchette, MacDonald, & Langer, 1985) is an important tool to determine if certain times and events seem to occasion higher levels of problem behavior across time. It provides general information on possible time periods across the day that seem to promote higher rates of behavior than other time periods.

In the study by Touchette et al. (1985), a scatter plot was used to gain information on the antecedent conditions for the assaultive behavior of a 14-year-old female. She had a history of such behavior from the age of 4. In her current placement, she would assault both peers and staff at the residential school for students with autism. Staff plotted assaults as a function of 30-minute intervals. These data were transformed to a new grid, which made it easier to view patterns of target behavior. If a given 30-minute block of time had only one assault, an open circle was placed on the new grid for that time period. More than one assault during a 30-minute block of time required a filled-in circle to be placed on the new grid. Blocks of time during which no assaults occurred had no circle. This new grid would reveal longitudinal patterns of behavior.

By examining this grid for filled-in circles, these researchers identified specific time periods between 1:00 and 4:00 p.m. during which multiple assaults were occurring. From

ASSIGNMENT: CONSTRUCT A TRIGGER ANALYSIS WITH BEHAVIORAL DESCRIPTION

Using a hypothetical client who engages in property destruction, delineate the procedures to be used for a trigger analysis with behavioral description if the suspected EO is escaped from difficult class assignments.

• Describe the contrived EO condition for this hypothesized function.

• Present a three-column sheet illustrating hypothetical data for one contrived EO trial.

• Assuming that your hypothesis is correct, explain what happens when the student engages in property destruction in the natural context; that is, what is the maintaining contingency?

• Explain how you might select a precursor behavior on some trials; that is, how would the information obtained from the test trial above be helpful in selecting a precursor behavior to provide escape from the difficult assignment?

68 Functional Behavioral Assessment, Diagnosis, and Treatment

Monday through Thursday during this time period, the student was in group prevocational and community living classes. In contrast, Fridays, Saturdays, and Sundays rarely contained assaults, and she did not attend these classes on those days. With this information, they redesigned her schedule. Her new schedule removed the afternoon classes that occasioned high rates of assaultive behavior. In their place, the activities she engaged in on Friday through Sunday, that seemed to not provoke assaultive behavior, were substituted. With this programmatic change, assaults immediately dropped to zero levels on multiple days. This was maintained over the next phase where the prevocational classes were progressively introduced back into her schedule. This progressive alteration of the amount of time she would spend in these classes occurred over a 1-year period. Data at the end of that 1 year was quite impressive. She was participating in three of the four class hours with only one assault occurring during a 14-day period.

To use the scatter plot as a mechanism for revealing patterns of behavior across the week, staff record occurrence of target behavior as a function of time of day. This is accomplished in time blocks, for example, 9:00 to 10:00 a.m., 10:00 to 11:00 a.m., and so on. You then examine the data across multiple days, looking for patterns of high rates and low rates of target behavior across the same time of the day. Table 2.25 is a hypothetical illustration of a scatter plot to identify patterns of “refusal to comply” behavior of an 8-year-old child with attention-deficit hyperactivity disorder (ADHD) in a third-grade elementary school classroom.

Table 2.25 plots the frequency of the target behavior, that is, refusal to comply, across 5 days of the week in terms of half-hour time segments for each day. One can then examine the data for patterns of behavior across certain time patterns or activities. For example, between 10:00 and 10:30 on Monday, the child refused to comply with a teacher request five times. Refusal behavior is highly likely during this period as evident by the data for the remainder of the week. In examining the scatter plot, two time periods (i.e., 8:30–9:00 and 10:00–10:30) account for the overwhelming majority of instances of refusal behavior during this 1-week period. One can then begin to examine more closely the antecedent conditions that are present in those time periods where higher rates of problem behavior exist. Once identified, these risk conditions for target behavior can then be used in designing an effective treatment. It is also important to note from the scatter plot data that there are certain time periods when refusal behavior was unlikely. This information is also valuable in ascertaining what contexts are “safe” conditions for target problem behavior. Collecting scatter plot data can aid in identifying risk and safe conditions for the target problem behavior.

TABLE 2.25 n SCATTER PLOT ILLUSTRATION: OCCURRENCE OF REFUSAL TO COMPLY WITH TEACHER/STAFF INSTRUCTION

Time of Day (a.m.)

M T W Th F

8:00–8:30 x x

8:30–9:00 xxx xx xxxxx xx xxx

9:00–9:30 x x

9:30–10:00 x

10:00–10:30 xxxxx xxxx xxxx xxxxx xx

10:30–11:00 x x

11:00–11:30 x x

2 Functional Behavioral Assessment of Problem Behavior 69

TABLE 2.26 n SAMPLE TIME PERIODS FOR SCATTER PLOT DATA

8:00–8:15 → arrived at worksite

8:15–8:30 → morning staff meetings

8:30–10:00 → cleans bathrooms in building

10:00–10:10 → break

10:10–11:30 → sweeps out and cleans cafeteria, mops up floor

11:30–12:00 → lunch

TABLE 2.27 n SCATTER PLOT ILLUSTRATION

Date: 3/9/05 Target Behavior: Tantrum Behavior at Worksite

Time of Workday

M T W Th F

8:00–8:15

8:15–8:30 xxx xx xxxx xx xxx

8:30–10:00 x

10:00–10:10 x

10:10–11:30 xxxxx xxxx xxxx xxxx xx

11:30–12:00 x

If you are attempting to monitor multiple behaviors with a scatter plot grid, you might want to code each target behavior at the top of each data sheet. For example, physical aggressiveness could be coded “PA,” and a “T” could represent tantrums incidents. Try to limit yourself to collecting scatter plot data on only two or three target behaviors at a time. The day should be divided into time periods that reflect natural divisions in regularly scheduled activities. For example, a scatter plot for a client attending a worksite might be designed to reflect the natural activities and breaks during the workday (see Table 2.26).

Table 2.27 is a scatter plot of this client’s tantrum behaviors according to the general activity and time period delineated in Table 2.26. The time period of 8:15 to 8:30 indicates a high rate of tantrums. Apparently, cleaning bathrooms does not generate many tantrums (see 8:30–10:00 time period). However, cleaning the cafeteria is another condition that results in high rates of tantrums (see 10:10–11:30).

In this hypothetical example, why would the client have minimal problems with cleaning the bathroom, but then have problems cleaning the cafeteria? Should we conclude that it is the nature of the specific tasks that generates tantrums? Although this is certainly possible, it may not be the primary factor. Perhaps it is the requirement to work with other coworkers when cleaning the cafeteria. If cleaning the bathrooms is done in solitude, while cleaning the cafeteria is done as a group, perhaps that is the problem. This client may not like to work with other people. If this client was required to join several people doing bathroom custodial duties, the client may exhibit some of the same problem behaviors. We don’t know which of these two possibilities creates an aversive EO for tantrums. However, the scatter plot data give you a place to start looking. It requires additional investigation

70 Functional Behavioral Assessment, Diagnosis, and Treatment

DISCUSSION QUESTION 2D Suppose you have collected scatter plot information on a student’s rate of leaving the classroom unauthorized. What information would the scatter plot data provide? What do you look for? What would the absence of the target behavior tell you?

in order to pin down possible behavioral functions and the relevant EOs. Once you identify the motivating conditions and discriminative stimuli that occasion such behavior it becomes possible to alter these conditions to get an immediate change in the target behavior (Touchette et al., 1985).

If you are going to collect scatter plot data in residential or inpatient facilities, consider tracking the client’s problem behavior as a function of activities. This is particularly ideal for clients who have an established routine during the weekdays. For example, the client may get back to the residence from the day program at 3:00 p.m. and have a snack that lasts for 10 to 15 minutes. This could be the first category under which frequencies of the target behaviors are recorded. Following the snack, the client changes clothes, and again, frequency of behavior should be recorded under that context.

Scatter plot data can be very useful in educational settings. You would set up blocks of time involving specific instructional tasks or content areas. To further delineate what might be a risk condition for target behavior, you can use a coding system to indicate specific activities. For example, seatwork would be “SW,” and reading groups would be represented by “RG.” You could also note if the task was a seatwork task or a task requiring the child to pay attention to the teacher. Table 2.28 provides some questions you might consider when examining scatter plot data.

TABLE 2.28 n QUESTIONS TO CONSIDER IN EXAMINING SCATTER PLOT DATA

1. Are there time periods when the behavior is highly likely?

2. What activities or events are typically associated with these time periods?

3. Are there time periods when the behavior is highly unlikely?

4. What activities or events are typically associated with these time periods?

Analogue Assessment Analogue assessment (also known as a functional analysis of behavior) involves an experimental analysis of the function of the behavior under contrived test conditions (Iwata, Vollmer, & Zarcone, 1990). These contrived test conditions attempt to simulate or mimic the variables hypothesized to be operating in the child’s classroom or school environment (Iwata, Dorsey, Slifer, Bauman, & Richman, 1982; Steege, Wacker, Berg, Cigrand, & Cooper, 1989). Analogue assessment utilizes a quick switching of hypothesized variables to determine the effect on the child’s behavior, comparable to conducting a scientific experiment. If the rate of behavior is reliably higher in one condition relative to other test conditions, then a hypothesis about a behavior’s function has further solid empirical evidence.

Analogue assessment is a more labor-intensive method that allows you to “test” potential hypotheses regarding why the behavior is occurring, in terms of controlling variables (Iwata et al., 1982, 1990; Lerman & Iwata, 1993). It has received extensive validation (Day, Rea, Schussler, Larsen, & Johnson, 1988) and is superior to other assessment methods described previously (Lerman & Iwata, 1993).

2 Functional Behavioral Assessment of Problem Behavior 71

Multiple EO-Function Comparison Tests. Analogue assessment methods were developed and empirically validated in a clinic for SIB and other problems at the Johns Hopkins School of Medicine (Iwata et al., 1982). The children referred to Dr. Iwata at the clinic came from various distances and locations, which probably precluded an analysis of their behavior in real-life (in-situ) environments. These researchers ingeniously developed an assessment protocol that allowed them to experimentally analyze the potential function of self-injury in a short period of time. In order to verify hypotheses about the problem behaviors’ functions, Iwata et al. (1982) attempted to mimic possible controlling environmental variables in the clinic setting. They developed four test conditions under which self-injury rates would be evaluated: (a) attention, (b) demand, (c) alone, and (d) play (enriched environment).

In the attention condition, the therapist’s attention was contingent on SIB, in the form of a disapproval statement such as “don’t do that” and touching the child lightly on the arm or shoulder. What would such a simulation demonstrate? If behavior rates increase during this condition, relative to the other conditions, one has strong evidence that attention is the maintaining variable. In the demand condition, escape-motivated functions were tested. The therapist would present task demands to the subject in the form of self-care or educational tasks every 30 seconds. The task would be removed for a 30-second period contingent on SIB. If the rate of problem behavior is heightened in this condition relative to the other conditions, then evidence of escape-motivated behavior exists for this aversive EO. In the alone condition, the client was placed alone in the therapy room, with no toys or other

CASE EXAMPLE 1

After reviewing information obtained via scatter plot and interview of school staff, you hypothesize that the referred child with ADHD has more frequent behavior problems when the seatwork is relatively difficult for him. This second grade student’s referred problem behavior consists of not finishing assignments coupled with frequent verbal complaints about the assignments. You suspect that such behavior serves an escape function and appears to be very likely with difficult seatwork. The socially mediated escape function would involve the teacher temporarily halting the task when the student begins or continues to complain.

To test this, it is essential to set up a two test conditions. Since difficulty of the material seems to be the factor in the problem behavior’s function, the presence and absence of difficult material would provide the needed comparison. Therefore, in some sessions you present easy assignments, while in other sessions you present the hypothesized difficult assignments. If the degree of difficulty is not the variable, you could also conduct some sessions with no assignment. Therefore, in brief sessions, difficult tasks are going to be interspersed with separate sessions where easier tasks are presented. You will record the frequency or rate of problem behaviors under each of these two conditions. As the consultant, you will implement the analogue assessment in a separate room.

Further, to mimic the hypothesized classroom conditions, the occurrence of verbal complaining will be reinforced by your temporary removal of the task (in either the difficult or easy conditions). For example, if this student proclaims, “This is stupid, I don’t need to know who Captain Cook is!” you would comment, “OK, why don’t you take a break for a while. I will call you back when you are rested.” After 30 seconds of allowing him or her to get out of the seat, you call the student back again. However, contingent upon any verbal complaining, you allow the student another 30­second break. Therefore, in this analogue test, the occurrence of the problem behavior in either of the task conditions (easy vs. hard) is allowed to serve an escape function (i.e., negatively reinforced with the brief removal of the task).

If there is differential responding in problem behavior, in favor of higher rates during difficult tasks, one can surmise the conditions under which such escape problem behaviors become more probable. Therefore, the hypothesis of escape from instruction­task difficulty seems to be more plausible.

72 Functional Behavioral Assessment, Diagnosis, and Treatment

CASE EXAMPLE 2

A female client has been referred to you who lives in an institutional setting. She engages in severe property destruction. After reviewing information obtained via behavioral interviewing, you hypothesize that her property destruction seems to occur in the context of requests or demands made of her by staff. You will test this out by alternating 10­minute sessions of simple requests with sessions having no task demands. In one condition, you present the types of task demands made by staff (e.g., “Come here and put on your sweater.” “Pick up this towel.”). In the other condition, no requests or demands are made of her. Therefore, in short alternating 10­minute sessions, imposing demands of this client are interspersed with no task demands (alone condition), while the frequency of tantrums and property destruction is recorded under each of these conditions.

Further, to mimic the hypothesized classroom conditions, the occurrence of problem behaviors (tantrum or property destruction) results in you (the behavioral specialist) leaving her alone for a while (e.g., 30 seconds). In other words, the demand situation is removed contingent upon the target behavior, thus simulating what the natural environment would do if such a behavior is truly serving an escape function. If there is differential responding in problem behavior between the demand condition and the no­demand condition, in favor of higher rates during demands, you can surmise the conditions under which such escape behaviors become more probable. Therefore, the hypothesis of escape from task demands and chores seems to be more plausible.

It may also be the case that it is the manner in which the demands are presented that makes a demand an aversive EO. The analogue assessment can be constructed to address such a possibility. The two conditions that would be tested might then be the following. In one condition, the demand is made in a harsh tone. In the other condition, the demand is made in a conversational manner, with the word “please” included in the request. If the manner in which the demand is made makes it an aversive condition (or not), the results would show a differential rate of problem behavior. If the rate of the problem behavior is about the same in either condition, then the manner of presentation is not a factor.

materials. This condition tested the possibility of sensory reinforcement function for the behavior. If self-injury occurred frequently in this condition, one could most probably rule out socially mediated functions. Finally, a control condition (play or enriched environment) involving access to toys and materials served as contrast between the other experimental conditions. In this control condition, pleasurable activities were provided noncontingently, thus removing the EOs for attention, tangible items, and aversive tasks.

Simulation of plausible natural contingencies under these various test conditions allowed the researchers to determine possible controlling variables of the SIB. The ability to discern a pattern of target behaviors by a quick switching of these four conditions across time gave these researchers experimental proof of the problem behavior’s function. The Iwata and colleagues, (1982) assessment protocol can be used when such information is needed in a short period of time. The research data involving the efficacy of this methodology in developing effective functional treatments is overwhelming.

Single EO-Function Hypothesis Tests. Analogue assessment can also focus on testing a specific hypothesis about a problem behavior’s function. This assessment methodology is a slight departure from the pioneering study by Iwata et al. (1982) in that only one hypothesis is tested at a time. The two conditions involved in this test are: (a) presence of EO and (b) absence of EO. The following two hypothetical case scenarios illustrate this methodology.

In school settings, analogue assessments can provide additional useful information in determining the function of problem behavior during seatwork. For example, suppose you hypothesize that the child’s disruptive behavior is serving an escape from instruction function due to lengthy seatwork assignments. The analogue test would involve the following characteristics:

2 Functional Behavioral Assessment of Problem Behavior 73

�l Quick switching between two conditions: (a) sessions involving a short assignment and (b) sessions involving a lengthy assignment(s). Get the same (or similar) materials that are used in class (since length of assignment is the EO and not difficulty).

�l For four sessions, present assignments that last an entire 50 minutes (full = F), that is, student keeps working continuously for 50 minutes, with one instructor in one test area. If the individual finishes the assigned material, provide another assignment (i.e., finishing work should not escape assignments, mimicking hypothesized natural classroom conditions).

�l For four sessions, present short assignments that last only 10 to 15 minutes (short = S). Once the assignment is finished, end the session, and go to an entertaining activity. Provide a cue that the condition involves a short amount of work, for example, “Let’s do just this one task before we take a break.”

�l Brief removal of task assignment is contingent on the problem behavior in both short- and full-length conditions (e.g., “why don’t you take a short break?”).

�l On-task behavior should be measured across both conditions. �l Comparison of rates of problem behavior and on-task behavior between these two

conditions is used to verify the hypothesis.

A possible hypothetical sample of an analogue assessment, with resulting data for several 50-minute sessions (F) versus several short sessions (S), is presented in Table 2.29 (frequency of behaviors and on-task rate in rows two and three). In examining these data, the rates of problem behavior are higher in the 50-minute sessions (frequencies of 8, 7, 12, and 6) than in the short sessions (frequencies of 1, 4, 1, and 0). There also exists a significant discrepancy in the on-task rate between full instructional sessions versus short sessions. It is obvious that the child has more frequent problem behaviors during longer assignments, as well as reduced time on-task.

Simulation Exercise: Analogue Assessment

This simulation can be done with a comparison of two conditions in evaluating puta- tive access functions: EO present (i.e., desired item removed) versus absent (i.e., desired item not removed). Stipulate to the observers what the target behavior con- sists of. In a 5-minute session, for access functions, you would remove the desired item (or attention) and then provide it back for just a few seconds contingent upon the target behavior. The volunteer is asked to demonstrate several behaviors, but in the EO present condition, the target behavior should be frequent (and conversely low in the EO absent condition). The observers record the frequency of the target behavior in both conditions. Compare the data after the session and repeat to obtain a practice effect.

TABLE 2.29 n DATA FOR ANALOGUE ASSESSMENT

Session 1 2 3 4 5 6 7 8

Full or short F F S F S S F S

No. of behaviors 8 7 1 12 4 1 6 0

On­task % 40 30 70 25 60 75 45 65

74 Functional Behavioral Assessment, Diagnosis, and Treatment

DISCUSSION QUESTION 2E In an analogue assessment, why does the therapist/teacher/staff person provide specific reinforcement when the client engages in the target behavior? Why would you want to reinforce the target behavior?

In many educational and mental health settings, extensive use of analogue assessment will probably be prohibitive due to time and fiscal constraints. So when would its use be most appropriate? There are three compelling reasons for utilizing this strategy: (a) when several prior behavioral programs have not succeeded in reducing the problem behavior, (b) before a student loses his or her current educational or residential placement, and (c) when there is a huge time and resource investment in training a large number of staff to implement a plan.

ASSIGNMENT: SINGLE EO-FUNCTION HYPOTHESIS TESTS

Using a hypothetical client who frequently leaves the classroom, delineate the procedures to be used for an analogue assessment single EO-function hypoth- esis test, if the suspected EO is the presentation of difficult class assignments. Address each of the points below.

• Describe the contrived EO condition for this hypothesized function.

• How is this hypothesis used to construct the two different conditions of this analogue test?

• How is this method different from the original functional analysis of behavior methodology in the 1982 Iwata and colleagues study?

• What happens when the target behavior occurs (in either condition)?

• Present a graph or table of data that illustrates that such an EO is actually the motivational condition for this student’s leaving the classroom.

TABLE 2.30 n DATA ON EASY VERSUS DIFFICULT TASKS

Session 1 2 3 4 5 6 7 8

Easy or difficult D E E D D E E D

No. of behaviors 12 0 3 7 14 2 1 18

On­task % 20 80 85 30 30 65 80 15

In a similar vein, a test of the problem behavior serving an escape function due to task difficulty could be done with another student. Again, with the occurrence of a target problem behavior, the assignment or task is stopped for a 1- to 2-minute break, then reintroduced. A possible hypothetical sample of data across eight brief sessions of 10- to 15-minute durations (consider child’s grade level) is presented in Table 2.30 for the two sets of conditions: difficult tasks (D) versus easy tasks (E). One can see by the data collected that the presentation of difficult tasks generates high frequencies of problem behavior and low rates of on-task behavior. Conversely, easy tasks generate a low frequency of problem behavior and high rates of on-task behavior.

2 Functional Behavioral Assessment of Problem Behavior 75

Analogue tests can also be conducted with other socially mediated access and escape problem behaviors (see Table 2.31). For example, some clients have difficulty when presented with a novel task or routine. This can be tested in a contrived condition by alternating the presentation of novel tasks with familiar tasks (see Example 1 in Table 2.31). The same requirement for allowing the problem behavior to terminate the condition would be in effect for both conditions. In Example 2, a test of the antecedent for socially mediated problem behavior involving an inability to wait for a reinforcer is tested. In one condition a wait of some interval is imposed, with the target behavior being given after some criterion level of problem behavior has been demonstrated. A differential result between the wait condition and the no-wait condition would provide evidence regarding a hypothesis of tangible reinforcer.

When I Say “NO!” Fred was an individual who was referred to Keven Schock for evaluation of severe SIB. In its most severe form, his SIB involved tearing pieces of flesh from his legs and throwing them at staff members. This resulted in significant levels of blood loss and significant risk to his life. Given the severity of this behavior, the facility had responded with progressively more restrictive procedures. These procedures included 1:1 staffing, psychotropic medications, and locked, hard plastic boots to prevent access to his legs.

Keven’s first observation of Fred’s SIB revealed a sequence of behaviors that he engaged in prior to the severe form of self-injury. While Keven was observing him, a staff person came into his room and asked him to go wash his hands before breakfast. He said “no.” The staff person then insisted that he must get ready for breakfast and told him again to go wash his hands. He then began screaming “NO.” The staff person again told him that he must wash his hands; he continued to yell “NO” and began to spit at the staff. The staff again directed him to go wash his hands. Fred then stopped spitting and attempted to hit the staff person. The staff person stepped out of the way and again repeated the direction to wash his hands. He stopped trying to hit the staff and began pinching his own arms. The staff person now prompted him to stop pinching himself and go wash his hands. Fred then began grabbing the flesh on his legs causing a wound and bleeding. The staff person blocked Fred from grabbing his legs and called emergency staff. The emergency staff attended to his wounds, but no more requests were made to wash his hands.

Keven Schock then talked with staff who had worked with Fred for several years and had indicated that the most likely conditions to evoke the self-injury were repeated and persistent demands to complete any task. Staff who had reported success in avoiding self-injury told me that they simply stopped task demands when he said “no” and would re-present those demands in 15 minutes, at which time Fred would typically comply with the request.

Keven presented the findings from the descriptive assessment to the treatment team. Despite the data depicting clearly the function of escape from a social demand, the team disagreed with his findings. They were insistent that Fred was engaging in SIB for attention. Their logic was the following: when Fred engaged in the severe form of SIB, that is, throwing his pieces of skin at them, multiple staff members came to interact. When multiple staff arrived, he would then stop tearing flesh from his legs. Subsequently, he received one-on-one attention from the nurse. Rather than engaging in a protracted argument, Keven offered to provide empirical support that this behavior was maintained by escape. To provide such data, he tested three

TABLE 2.31 n ANALOGUE TESTS

Hypothesized EO Condition A: Presence of EO

Condition B: Absence of EO

Other Considerations

Example 1: Novel tasks

Novel tasks presented consecutively

Familiar tasks Equate length of time between both conditions

Example 2: Inability to wait for desired item/ event

Wait time required from request (e.g., 1–5 minutes)

No wait time from request

Require some criterion level of problem behaviors to produce reinforcer

EO, establishing operation.

76 Functional Behavioral Assessment, Diagnosis, and Treatment

different conditions. In this case, due to the form of Fred’s severe SIB, he selected a precursor form of self-injury (pinching and pulling on the skin of his forearm) as the response measure during one of the three test conditions. In all conditions simple demands to complete tasks, such as get out of bed, go to the day room, hand me the towel, and so forth, were delivered. To test the escape function, the ability to escape the task demand was evaluated as a function of continued demands. Therefore, in one condition the task demands were stopped for an alternate behavior, and in another condition they were terminated contingent upon the less severe form of SIB. A third condition evaluated a temporary delay in the advent of the next compliance request. The three test conditions are presented in Table 2.32.

�l Condition 1—The task demands were stopped any time Fred said “No.” �l Condition 2—The task demands continued after Fred said “No” and were terminated

when he completed the task or when he engaged in the less severe form of SIB. �l Condition 3—The task demands were terminated when Fred said “No” and then

represented after a 15-minute delay.

A session consisted of presenting each of the three conditions per day, with a 1-hour interval between each test condition. This type of data was collected for 4 consecutive days. Data were recorded for occurrences of self-injury in all conditions. Compliance with demand was recorded only for condition 3. The last column indicates whether compliance occurred in condition 3 after the command was presented the second time, that is, after he said “no.” Keven included this condition and additional data on compliance because some staff members reported that he would comply if you re-presented a demand after a brief delay (see Table 2.32).

When tasks demands were stopped when he said “no,” the rate of SIB was zero. The function of escape is further illuminated when one compares this with what happened in condition 2, where SIB produces escape (rather than saying “no”). Also, staff perceptions about his SIB behavior being less likely when you wait a short time to re-present the demand after the initial refusal seemed correct. Self-injury was absent during this condition, while compliance to the second request occurred three times.

Based on these data, Keven was able to demonstrate that attention was an incidental variable involved in the severe form. Consider that when attention was given to Fred when he picked flesh from his legs, he also experienced a removal of the task demand. It was the latter stimulus change that was driving his behavior, not the attention that also resulted. Keven designed a simple intervention that resulted in 0 occurrences of severe SIB immediately upon implementation. The plan was successful over a long period subsequent to the initial contingency change. Over the next 2 years, there were no occurrences of the severe SIB. There were two occurrences of the less severe SIB. Both occurred when Fred was at medical appointments and the medical staffs at the facility were insistent that he comply with their demands even after he had refused.

TABLE 2.32 n DATA ON SELF­INJURY FOR CONDITIONS AND DAYS

Number of Occurrences of Self-Injurious Behavior

Condition 1 Condition 2 Condition 3 Compliance With Demand on Second Request (Condition 3)

Day 1 0 3 0 Y

Day 2 0 5 0 Y

Day 3 0 1 0 N

Day 4 0 2 0 Y

2 Functional Behavioral Assessment of Problem Behavior 77

In-Situ Hypothesis Testing An in-situ hypothesis test uses a design similar to that described in analogue assessments, that is, a quick switching of conditions. However, an in-situ hypothesis test contrasts with an analogue assessment in two dimensions: (a) it is conducted in the setting of interest and (b) a functional treatment (based on the entertained hypothesis) is alternated with a baseline condition (Repp, Felce, & Barton, 1988). In this manner, a comparison is made between the rates of problem behavior during the functional treatment and the rates of behavior during the baseline (i.e., treatment not implemented).

The personnel in the in-situ setting (school, home residence, treatment facility) implement the data collection for the two conditions for only a brief period of the day, rather than across the entire day. The test is not conducted across the entire target time period. Rather, it is abbreviated in length, as its purpose is merely to test and not treat (at this point). At select time periods, across a week to several weeks, the professional alternates two conditions—baseline and treatment conditions. For example, in a school setting, the manner of conducting this assessment would be the following during a math period. On one day, during math period, the baseline condition is implemented. The following day, during math, the treatment condition is implemented. The following is a case example of this assessment method.

I Hear Voices. In-situ hypothesis tests are well suited to assessing the symptoms of mental illness. Consider the case of Joann, a 41-year-old female who had been diagnosed as having schizophrenia. She frequently would report that she heard voices telling her to harm herself. She often reported that she felt worthless and that she had let her family down by “getting mental illness.” Keven Schock developed an initial hypothesis involving this class of verbal behaviors as maintained by staff (adult) attention. He observed that her talking about hearing voices resulted in staff talking with her for extended periods of time. Such behavior appeared to be functional in accessing protracted conversations, with staff becoming an interested audience. Here is a great example of this function. A staff person might ask her how the meds were working. At that point, she began to talk about “hearing voices.” This led to multiple questions from the staff about the content of the “voices,” with a conversation that could last 15 minutes. Unfortunately, the times when she tried to start a friendly, but nonsymptomatic conversation, the opposite result occurred. The staff person would be polite, but the conversation lasted less than 1 minute. It seemed like lengthy attention from staff was the differential consequence that explained her verbal behavior. Keven set up two test conditions to see if two rates of symptomatic behavior would result.

The usual contingencies were kept in place at the mental health center. This required no manipulation of what had previously happened when Joann reported hearing voices. The staff person would talk with Joann and ask her about the content of her hallucinations. The length of social interaction was typically dependent on Joann reporting higher levels of hallucinations and describing the content of the hallucinations in some detail. This is termed condition 1. Every report about hallucinations and hearing voices was tallied in this setting.

Keven implemented the test condition in her home (condition two). The same behavior (reporting to staff that she was hearing voices) was the dependent measure. The staff members in the home were instructed to provide differential levels of social attention dependent on the content of her conversation. The staff responded to any reports of auditory hallucinations by simply saying, “What coping skills are you using for that?” and then a prompt to Joann to, “Go practice them and let me know how it worked.” However, if Joann initiated a conversation that did not involve references to auditory hallucinations, the staff would simply talk with her about the topic she presented during the appointment. In other words, a treatment based on attention only was deployed in this setting. If the symptomatic behavior went down in the home while still remaining at heightened levels at the center, the data confirm the attention hypothesis. Each test condition was in place on alternating weeks (for a total of 8 weeks). Results are presented in Figure 2.1. These data clearly demonstrates that for this individual, the reports of auditory hallucinations functioned to access staff attention.

It’s Attention I Desire. The case of Marta, a 28-year-old female who was diagnosed with borderline personality disorder, was referred to Keven Schock. She engaged in several

78 Functional Behavioral Assessment, Diagnosis, and Treatment

difficult behaviors, including threats to harm herself as well as an incident involving a self- administered overdose of medications. Keven had the opportunity to observe Marta both at a drop-in socialization center and when she initially moved into his facility. He noted that when she made a threat to harm herself there was a dramatic increase in the level of social interaction from her peers and the professional staff at the center. All she needed to do was to say “I don’t feel like living anymore, no one would care if I disappeared,” and staff came to her immediately. Standard operating policies in the mental health system required that professional staff assess her risk of suicide immediately. Therefore, all verbal threats were taken as a potential prelude to the actual act of hurting oneself and attempting suicide. Of course, the process of assessing this risk necessarily involved a great deal of one-on-one interaction with staff. The incident of her overdose on medication also resulted in both immediate increases in social interaction, starting with the emergency transport to the hospital and continuing with the medical staff once admitted to the hospital.

Based on these direct observations, Keven hypothesized that her threats and attempts to harm herself were maintained by staff attention. He decided to empirically determine if attention was the maintaining contingency by conducting two test conditions. In the first condition, noncontingent continuous attention from staff was provided for the entire day. In the second condition, the usual level of staff interaction was provided. These two conditions were presented in an alternating fashion on 6 consecutive days. The results were rather dramatic. There were no threats to harm herself and no attempts to harm herself on the days when attention was provided noncontingently. There were multiple threats to harm herself on the days that attention was at usual levels (see Table 2.33).

Based on this in-situ assessment, Keven and staff were able to determine that the problematic behaviors that had led to a diagnosis of borderline personality disorder were maintained by staff attention. They were then able to design an effective treatment that involved an initial habituation phase of continuous noncontingent attention and then thinning the schedule of staff attention. The intervention also included the development of a network of peers to provide sufficient levels of social interaction.

In Classrooms. How would you use in-situ hypothesis tests in educational settings? You believe a child’s problem behavior in an elementary special day class serves to access teacher attention on some intermittent basis. The in-situ hypothesis test for teacher attention

Trial

1 0

45

40

35

30

25

N um

b er

o f

ha llu

ci na

ti o

ns r

ep o

rt ed

20

15

10

5

50

32 4

Usual contingencies

Differential attention

FIGURE 2.1 n Report of hallucinations under usual and differential attention conditions.

2 Functional Behavioral Assessment of Problem Behavior 79

as the maintaining variable would involve 6 to 10 short sessions (30–45 minutes in length) over a 2-week period. For half the sessions, the teacher would not alter the usual manner of managing the student (baseline condition). For the other half of the sessions, if the child was engaged in work, the teacher would systematically provide attention in the form of social approval and points for on-task behavior. Therefore, in the functional treatment condition, a treatment addressing an attention hypothesis is implemented for a short period of time during the day. If problem behaviors are dramatically more frequent during baseline sessions, the maintaining contingency would seem to be teacher attention.

An in-situ hypothesis test provides the following advantages:

�l It is a direct assessment of the target behavior in the setting of interest, with all relevant contextual variables present.

�l If treatment fidelity is obtained, an effective treatment is discovered, leaving only the requirement to develop staff monitoring for extended periods of application.

�l The staff, parents, and teachers who implemented the test will probably need less convincing that an effective treatment will be worth the time because they “had a hand” in the test.

Why Did You Do That? Some naive people ask the children or clients, “Why did you do that?” The individual being asked supposedly examines his or her thought process and purposes behind such behavior and then provides an answer. In other words, the purpose of behavior is often assumed to be available by simply asking the client to engage in self-introspection. The following is a hypothetical scenario of such an interaction.

Teacher: Jose, why did you hit Bobby? Jose: Well, Ms. Farrier, I believe that I am more likely to hit other students when we

both want the same thing. I have noticed that when I hit most of the children on the playground, they pretty much back away from whatever it is I want. I then get access to the item, toy, or activity, unencumbered by anyone else. I guess my hitting capability is pretty effective in accessing tangible reinforcers and is maintained because of this effect it has on the other children. I guess being “feared” on the playground has its advantages.

Teacher: Well thank you, Jose, for your fabulous insight.

Now there is an insightful analysis by this student of his aggressive behavior’s function. If that does not sound like anything you have heard, that is because it never happens like that in real life! Here is a more typical scenario.

TABLE 2.33 n DATA UNDER EACH CONDITION

Day NCR Attention Usual Attention

1 6 threats to harm herself

2 0 threats

3 8 threats to harm herself

4 0 threats

5 4 threats and 1 attempt to harm herself

6 0 threats

80 Functional Behavioral Assessment, Diagnosis, and Treatment

Teacher: Jose, why did you hit Bobby? Jose: I don’t know. Teacher: What kind of answer is that? Jose: I don’t know. He makes me mad. Teacher: He makes you mad? How do you think he feels when he gets hit? Jose: I don’t know.

If asking the individual why he exhibited a particular behavior would lead to an FBA, we would be writing the chapter solely on functional treatment. At least in the year 2016, it is still necessary for a person with training in behavior analysis to collect several sources of objective and subjective data when determining why somebody does something.

WHAT IS NOT AN FBA? FBA has grown in popularity since it was specified as a federal requirement for special education students with disabilities who engage in certain problem behaviors. A common approach to this requirement from personnel who do not understand that a function exists in the presence of a specified EO is to simply list all the activities and events that occur prior to the behavior in one column (called antecedents). Concurrently, these untrained personnel then observe and record all the staff responses that occur subsequent to the behavior. These are listed in a column to the right of the behavior. Their analysis then concludes that antecedents for the target behavior can be any of a number of events and stimuli. Concurrently, the consequences of the behavior can also be any of a number of events that follow the response. Table 2.34 illustrates this (technically incorrect) format for analyzing problem behavior (often found in many reports called FBA).

It should now be clear that this type of analysis ignores basic tenets of an FBA in this text. Note in Table 2.34 that one of the antecedents for verbal abuse and oppositional behavior (which would need a more pinpointed definition) is during instruction. If such behavior is more likely under this condition, which of the consequent events listed in the third column is the maintaining contingency? The answer is: We don’t know because the author of this type of report is probably oblivious to a true understanding of behavioral function!

An FBA does not simply entail a listing of observed phenomena! One must examine data and information and make sense of it. One should conclude that the target behavior is maintained because of what it produces or removes reliably in the social or physical environment, under a given EO. Now that you have read this material, be an advocate for the correct deployment of an FBA in school and other settings. Point out that the analysis in Table 2.34 does not reflect sufficient knowledge for the author to claim an FBA has been conducted!

TABLE 2.34 n NONEXAMPLE OF FBA

Antecedents Target Behavior(s) Consequent Events

During instruction Verbal abuse and oppositional behavior

Negative teacher attention

When bored Peer attention

Too much light Controls environment

Not enough light Gets his way

Too much noise

When playing games with others

FBA, functional behavioral assessment.

2 Functional Behavioral Assessment of Problem Behavior 81

TABLE 2.35 n ECOSYSTEMIC ASSESSMENT OF CLASSROOM CONTINGENCIES

1. Is student on­task behavior systematically producing a powerful reinforcer? a. Is on­task behavior or attending behavior systematically and frequently monitored (and

not via a daily rating scale)? b. When the student engages in higher rates of on­task behavior, is either a conditional

reinforcer (points) or a tangible reinforcer provided? c. When a student engages in high rates of on­task behavior, is the result more work (i.e.,

additional nonpreferred assignments) until the end of the time period? d. When a student has a lower rate of on­task behavior during a period, does he lose

access to a designated reinforcer? e. Is the reinforcer potent enough to motivate the student day in and day out?

2. Is student assignment completion systematically producing a powerful reinforcer? a. Is completing assignments systematically and frequently monitored (does teacher

immediately receive material when student completes assignment)? b. When the student completes an assignment, is either a conditional reinforcer (points) or

a tangible reinforcer provided at that point? c. Is a Premack contingency in effect for completing work? Does the student get access

to a high­probability behavior contingent on successful (accuracy) completion of a prespecified amount of class assignment?

d. When the student completes an assignment, is the result another assignment (without earning points) for them to complete until the end of the time period?

e. When the student fails to complete an assignment on a given day, does the student immediately lose access to a designated reinforcer?

f. Is the reinforcer potent enough to motivate the student day in and day out? 3. Is there a reinforcement program in effect targeting specifically problem disruptive behavior

by the student? a. Is disruptive behavior defined in discrete terms and recorded with each occurrence? b. Is there a behavioral standard, across a period(s), half day, or full school day that

delineates the number of disruptive incidents that will involve removal of a specific contingent reinforcing item or event?

c. Over the last 2–3 weeks, how often has the student earned such a reinforcer, and how often has the student lost access to this reinforcer?

ECOSYSTEMIC ASSESSMENT Is it necessary to conduct an FBA for every significant behavior problem? It might very well be that simply correcting “wacky contingencies” in the classroom (or other settings where task demands are made) would produce the desired effect (see Chapter 3). In classroom settings, contingencies for desired classroom behavior should be considered first, whether such are produced for on-task behavior, assignment accuracy and completion, or the absence or low rates of problem behavior. An ecosystemic assessment of the existent classroom contingencies may reveal inequities in differential reinforcement (see Table 2.35).

If the rate of on-task behavior does not matter, in terms of access to preferred events, then on-task behavior is of no consequence. Whether a student is on-task 20% or 80% of the time does not affect the length of time with preferred activities. Similarly, if completing assignments results in the same access to preferred events as failing to start the assignment, then there does not exist a powerful contingency for assignment completion. Finishing the assignment does not produce a different result for the student than not finishing the assignment in the short term. The only probable contingency of repeatedly failing to finish class work is lower grades, which may not be an effective contingency.

82 Functional Behavioral Assessment, Diagnosis, and Treatment

Depending on your findings, you may conclude that designing an individualized or class- wide contingency management plan that either differentially reinforces acceptable levels of on-task behavior, differentially reinforces assignment completion, or targets disruptive behavior is indicated before resorting to an FBA and treatment. For on-task behavior, an efficient management strategy is the beeper system (Erken & Henderson, 1989). Beeps at unpredictable intervals require the teacher or student (if self-management is utilized) to determine if on-task behavior is occurring at that point in time (i.e., momentary time sampling). The teacher initially designates a level of on-task behavior that accesses a powerful reinforcer (e.g., 60% on-task rate accesses the designated reinforcer). If 20 unpredictable beeps occurred in a 1-hour period and the student rated self on-task for 12 of them, the rate of on-task behavior is 60%, and the student would earn the reinforcer. Differential reinforcement procedures can be used to address other classroom management inequities in class-wide performance problems.

CONDUCT A PERFORMANCE DISCREPANCY ANALYSIS A performance discrepancy analysis is the final step in determining whether the referred problem behavior is indeed at problematic levels. As indicated before, behaviors that impair the health and welfare of the client or others are apparent and require immediate intervention. However, with other behaviors, such as noncompliance, off-task behavior, failure to follow directions, or tantrum behaviors, there does not exist a readily available standard to determine whether the client’s level of behavior falls within age-appropriate norms. One would likely assume that the acceptable level of behavior can be a function of several variables, such as age of the child or client and context. The basic question for these problem behavior referrals is: How much of this behavior is too much (or often)?

Let us examine the hypothetical case of a 4-year-old boy referred to you because he doesn’t follow directions at home. Your data-gathering efforts may find that there are certainly occasions when he doesn’t follow directions. However, there are also occasions when he does follow directions. Is this child in need of intervention? Without entering any personal bias, the question becomes, “What is an acceptable level of noncompliance in a 4-year-old child under certain events or activities?” Surely, we do not expect the child to be compliant to all presented instructions and requests every day (please separate delusions from reality here). On the other extreme, never following instructions is certainly unacceptable. What is the happy acceptable medium? A performance discrepancy analysis allows you to determine, in an objective manner, the behavioral standard for acceptability. You can then judge where the current child’s behavior falls in relation to that standard.

A performance discrepancy analysis involves a comparison of the rates of a client’s problem behavior with the acceptable level (or rate) of that behavior. How does one determine what is an acceptable level of any behavior? A method for objectively determining what is an acceptable level of a behavior is the normative comparison method (Kazdin, 1977; Matson, Esveldt-Dawson, & Kazdin, 1983). The method allows one to identify, in measurable terms, the norm for one behavior under specific antecedent conditions.

In utilizing a normative comparison method, one first identifies same-aged peers or persons who are judged to be nonproblematic with respect to the behavior. For example, if you were trying to determine what is an acceptable level of noncompliance for a referred 4-year-old child (noncompliance as a percentage of noncompliance to total first requests), you would want to identify a number of 4-year-olds whose parents or teachers report that they do not have a serious problem with noncompliance. This process is called the criterion group selection (Kazdin & Matson, 1981).

Once the criterion group is selected, you want to measure the occurrence of noncompliance with the criterion group under the same situations as those identified as generating noncompliance in the target child. To simplify potential logistical problems, you can select children who are readily available at your particular site. Once these data are available, you would not need to go out again and repeat this part of the process for other referrals. The observation of these children in the criterion group as well as observation of the target child should occur over multiple observation sessions so that a stable rate of the behavior for each child can be obtained. You have now established a norm with respect to the level of the behavior that is deemed acceptable.

2 Functional Behavioral Assessment of Problem Behavior 83

TABLE 2.36 n NONCOMPLIANCE DATA ACROSS 10 CHILDREN

Child % Noncompliance

1 24

2 33

3 42

4 41

5 37

6 69

7 28

8 81

9 44

10 33

If this aspect of the performance discrepancy is difficult to gather, that is, observing same- aged peers, you may be able to substitute interview data from other teachers or parents for the norms of acceptable behavior. However, realize that such data may not be as reliable as direct observation of a criterion group. Often people verbally state one standard, for example, “All children must raise their hands whenever they want to be recognized,” whereas direct observation may reveal that it is not an exacting standard. Although children may often raise their hands to be recognized, there is a small percentage of times when other behaviors result in recognition by the teacher. If interview data will be the method by which you collect data on the criterion group, try to identify the percentage of occurrence by increments of 10% (0%–10%, 10%–20%, 20%–30%, 30%–40%, etc.).

With the data collected, you can then determine the ranges at which the noncompliant behavior is acceptable and the ranges of noncompliant behavior that appear to be socially unacceptable. As an example, let us say that you identified ten 4-year-old children for the criterion group. You directly measured their rate of noncompliance in target situations. The mean percentage of noncompliance computed across several observation sessions for each child in the criterion group was reported as in Table 2.36.

In examining the data in Table 2.38, with the exception of two children, the mean percentage of noncompliance is between 24% and 44%. This range of noncompliance can then be used as a basis for identifying an acceptable level of noncompliance and used as the standard when assessing and subsequently examining the target child’s level of noncompliance. Table 2.37 presents seven steps to follow in conducting a discrepancy analysis.

TABLE 2.37 n STEPS TO PERFORMING A DISCREPANCY ANALYSIS

1. Identify the problem behavior in observable terms.

2. Select a criterion group of same­aged peers in the same or similar locale.

3. Measure the occurrence of the target behavior of persons in the criterion group across several days under the same situations in which the referred client has problems.

4. Identify the range and average (mean) level of occurrence of the problem behavior.

5. Measure the target­referred­client’s problem behavior.

6. Compare the client’s rates of problem behavior with the criterion group’s range and the average rate of occurrence.

7. Identify any discrepancy between the client’s data and the criterion group data.

84 Functional Behavioral Assessment, Diagnosis, and Treatment

REVIEW PREVIOUS TREATMENTS IMPLEMENTED A review of previous treatments implemented should be conducted prior to the design of the intervention strategy. In some cases, the problem behavior may have been previously treated successfully. This review may provide an easy solution to the present concern. In other cases, one might be able to identify ineffective techniques. In reviewing previous treatments, the professional should still take into account the possibility that the maintaining variables might be different from the previous circumstances.

What are some issues to examine when reviewing documentation on previous programs implemented for a client’s problem behaviors? Previous treatments that were not written up in detail are hard to evaluate, in that the specifics of the treatment deployed are not delineated for your current examination. In addition, in reviewing previous effective or ineffective treatments, the professional must determine whether the treatment strategy was implemented with integrity. Sometimes, previously conducted treatments that were judged ineffective might have been proven effective if carried out reliably over a reasonable period of time. Judging the integrity of previous treatments may be hard to evaluate unless recorded data are available in anecdotal or objective form that demonstrate the integrity of the treatment implementation. Table 2.38 provides some questions to consider when reviewing previous treatments implemented.

If consent is obtained, it can really be helpful to interview staff at agencies that previously served the client. What may not be available in written documentation upon review are factors that may have led to the success or failure of the previous treatment. Talking to someone who was previously involved with the client’s treatment may allow you to discern if the previous treatment failed due to poor design, inadequate functional analysis, or poor implementation of the program procedures. When possible, with the client’s consent for disclosure of information, make the call!

DISCUSSION QUESTION 2F How is a performance discrepancy analysis used in determining the target objective? What is its function in an FBA?

TABLE 2.38 n QUESTIONS TO CONSIDER IN REVIEWING PREVIOUS TREATMENTS IMPLEMENTED

1. What was the focus of the treatment?

2. Is the current problem behavior the same or similar to that targeted in earlier interventions?

3. What was the treatment procedure? Was it effective in remediating the problem?

4. If a functional analysis was conducted, what was the conclusion drawn regarding the function(s) of the problem behavior at that time? Does the current problem look similar in function(s) to its previous function?

5. How extensive was the staff­training program? How were staff trained on the procedures of the program?

6. Has consent for release of information from the individual or legal guardian and agency administration been obtained, or can it be obtained to interview personnel from previous settings? Are the person(s) who were involved with the previous treatment available for contact?

2 Functional Behavioral Assessment of Problem Behavior 85

REVIEW OF HEALTH AND MEDICAL RECORDS A review of medical records and the files of the client may indicate contraindications to certain treatments. In other cases, it may reveal important factors that suggest a pattern of behavior. Does the behavior occur during certain seasons of the year or certain times of the month (Bailey & Pyles, 1989)? The records may also reveal that the problem behavior may be a side effect of medication the client is currently on (Bailey & Pyles, 1989). If any of these possibilities exist, a medical consultation and evaluation are recommended. The questions in Table 2.39 can be considered in light of a medical consultation as possible referral questions for the medical professional (adapted from Bailey & Pyles, 1989). When making the referral, minimally provide the medical professional with the problem behaviors and any information currently gathered through the current or previous behavioral assessments. Also, indicate to the medical professional that your request for a consult would be to evaluate the possibility of medical causes or interventions along with the concurrent use of a behavioral intervention program.

Self-induced vomiting. In some circumstances, behavioral data can guide you to the proper decision involving a medical consult. Nolan was a 28-year-old male who had been referred to Keven Schock’s facility to deal with self-induced vomiting. He had been treated for many years by the local mental health provider for various symptoms of depression and psychosis. He had been living in board and care homes for several years prior to his most recent admission to the inpatient psychiatric unit. The vomiting and concomitant weight loss had started about 3 months prior to his admission and had resulted in his losing placement in his group home as well as being admitted to an inpatient psychiatric facility because no obvious medical cause could be determined. Interviews with the inpatient staff and a review of inpatient records did not contain a notation of medical issues. The inpatient staff indicated that Nolan would simply go to the bathroom after a meal and vomit. When efforts were introduced to prevent this (a staff person accompanied him into the bathroom) he began to vomit in other areas of the psychiatric facility and deny that the vomitus the staff found was his.

Upon entry to the facility, Keven and staff began the process of observing him and attempting to determine what contingencies might be maintaining this behavior. We observed that the vomiting occurred after meals; however, it did not occur after eating a small food item such as a snack or candy bar. Quantity of food seemed to be a factor. Socially mediated contingencies were evaluated by examining the conditions present in the facility as well as reports from the prior psychiatric facility. Staff attention seemed unlikely because he made active attempts to avoid detection both while vomiting and to hide the vomitus seemingly to avoid detection. Tangible reinforcement seemed unlikely because no additional items were brought to him after vomiting. Escape as a hypothesis for the vomiting seemed

TABLE 2.39 n QUESTIONS TO CONSIDER IN REVIEWING MEDICAL/ HEALTH RECORDS

1. Could the problem behavior be the result of a medical condition of the client?

2. Is it possibly an allergic reaction?

3. If the client is or has been on medication, could the problem behavior be a side effect of the medication or a behavioral effect of the medication?

4. Are there any potential treatment procedures contraindicated, given the client’s physical and metabolic condition?

5. Could the problem behavior be an allergic or seasonal reaction?

6. Is this type of problem commonly treated effectively with medical interventions? If so, what are those procedures, and what is the role of the agency in their implementation?

86 Functional Behavioral Assessment, Diagnosis, and Treatment

unlikely because no demands were terminated after vomiting. There was no increase or decrease in social interaction following the vomiting behavior. It appeared to be a behavior that produced an immediate effect, that is, a direct contingency.

Keven made a full review of Nolan’s medical records and found that several years prior to his present admission, he had been hospitalized and treated for ingesting lye while living in another county. The record indicated that he had received several procedures to treat scar tissue that had accumulated in his esophagus. His assistant contacted the physician who had originally treated Nolan and asked if the procedures to treat the scar tissue could have any effect on his current problem with vomiting. The physician indicated that it was highly likely. Further, Nolan had been scheduled to have a procedure to reopen his esophagus 2 years prior, but when he moved they had lost touch with him. Keven and staff quickly scheduled Nolan for the necessary procedure. Following the procedure, vomiting events dropped to zero for the next 3 weeks. Nolan was discharged from the facility, and 1-year follow-up data indicated that the vomiting behavior did not recur in the community group home to which he was discharged.

SUMMARY This chapter presented five steps in conducting an FBA. First, the problem behavior has to be pinpointed into observable terms, thereby laying the groundwork for a reliable method of measuring the problem behavior. In addition to collecting baseline data on the rate of occurrence of the behavior, an FBA is conducted for the behavior problem, through one or several methods for collecting such data. Once all the data are collected, a performance discrepancy analysis is conducted to determine if the problem behavior is at excessive levels (relative to same-aged peers), and discrepancies are prioritized for intervention. Finally, previous treatments implemented as well as the client’s medical and health records are reviewed. With all these data, you are now prepared to analyze and interpret this information. In identifying the function of the problem behavior, you will now identify which of four diagnostic categories is most likely.

SELF­ASSESSMENT EXERCISES

• What are your thoughts on the “case of the intimate disclosure”? Do you think such unsolicited comments about one’s sexual history would be tough to treat (i.e., eliminate) via the removal of people’s attention (maintaining contingency)? How does this case relate to the previous chapter’s discussion about contrived contingencies?

• What is the advantage of using a trigger analysis for low­rate problem behaviors? What information (with respect to contextual variables—EOs) must the clinician have before using such a technique?

• In Table 2.14, I present three questions one should answer to determine whether a specific access or escape function is plausible. Explain what information each question seeks, in terms of zeroing in on the suspected contingency.

• What are some of the problems with descriptive assessment data as it is commonly used, for example, the often­used A­B­C chart?

• How does the trigger analysis with behavioral description presented in this book differ from the more common A­B­C charting method? How would you use such a method (trigger analysis with behavioral description) for discerning the function of a problem behavior?

• Provide some hypothetical entries for a trial using the trigger analysis with behavioral description for an escape function involving the presenting of difficult academic tasks (reading material far in excess of current capability) for a student. You can assume that

2 Functional Behavioral Assessment of Problem Behavior 87

Note 1. The difference between inducing an EO condition versus just describing behavior following

an observed possible EO rests in the ability to draw a cause and effect relationship. Experimental manipulations that involve inducing a condition and then returning back to the prior (control) condition can provide cause and effect conclusions. Descriptive methodology, which does not involve any active manipulation, can only portend a temporal relationship. While there may be a cause and effect inherent in such, the inability to manipulate the (independent) variable precludes a presumptionof causality.

REFERENCES Alberto, P. A., & Troutman, A. C. (2006). Applied behavior analysis for teachers (7th ed.). Columbus, OH: Prentice Hall. American Psychiatric Association. (2000). Global assessment of functioning (GAF) axis. In Diagnostic and statistical manual of mental dsorders (4th ed., text rev.; p. 34). Washington, DC: Author. Bailey J. S., Phillips, E. L., & Wolf, M. M. (1970). Home-based reinforcement and the modification of pre-delinquents’ classroom behavior. Journal of Applied Behavior Analysis, 3, 223–233. Bailey, J. S., & Pyles, D. A. M. (1989). Behavioral diagnostics. In E. Cipani (Ed.), The treatment of severe behavior disorders: Behavior analysis approach (pp. 85–107). Washington, DC: American Association on Mental Retardation. Barlow, D. H., & Hersen, M. (1984). Single case experimental designs: Strategies for studying behavior change. New York, NY: Pergamon Press. Barrish, H. H., Saunders, M., & Wolf, M. M. (1969). Good behavior game: Effects of individual contingencies for group consequences on disruptive behavior in a classroom. Journal of Applied Behavior Analysis, 2, 119–124. Bijou, S. W., Peterson, R. F., & Ault, M. H. (1968). A method to integrate descriptive and experimental field studies at the level of data and empirical concepts. Journal of Applied Behavior Analysis, 1, 175–191.

the AO is the removal of such a task and the provision of an easier, more preferred assignment (let us say such a task is reading material one grade level below student’s grade level equivalent on a standardized reading test).

• Describe the four conditions used in the functional analysis of behavior model developed by Dr. Brian Iwata and his team at Johns Hopkins University, published in 1982. Delineate the procedural requirements for implementing each condition.

• Explain why it is necessary to provide the reinforcer for the problem behavior in analogue test sessions.

• How is a single EO­function hypothesis test different from the multiple­EO function comparison analogue assessment? What are the advantages and disadvantages of each?

• Review the real­life case of When I Say “No!” in this chapter. Discuss the three test conditions that were compared; does the data make sense to you, and how? What does it say about the function of the problem behavior and how a 15­minute delay procedure ameliorates such an effect?

• What is the utility of an ecosystemic assessment of classroom contingencies? What information might this yield?

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Cantrell, R. P., Cantrell, M. L., Huddleston, C. M., & Woolridge, R. L. (1969). Contingency contracting with school problems. Journal of Applied Behavior Analysis, 2, 215–220. Cipani, E. (2004). Punishment on trial. Reno, NV: Context Press. Cipani, E., & Cipani, A. L. (2017). Behavioral classification system for problem behaviors in schools: A diagnostic manual. New York, NY: Springer Publishing. Cipani, E., & Schock, K. (2007). Functional behavioral assessment, diagnosis, and treatment: A  complete system for education and mental health settings. New York, NY: Springer Publishing. Cipani, E., & Schock, K. (2011). Functional behavioral assessment, diagnosis, and treatment: A complete system for education and mental health settings (2nd ed.). New York, NY: Springer Publishing. Day, R. M., Rea, J. A., Schussler, N. G., Larsen, S. E., & Johnson, W. L. (1988). A functionally based approach to the treatment of self-injurious behavior. Behavior Modification, 12, 565–589. Erken, N., & Henderson, H. (1989). Practice skills mastery program. Logan, UT: Mastery Programs Limited. Hall, R. V., Lund, D., & Jackson, D. (1968). Effects of teacher attention on study behavior. Journal of Applied Behavior Analysis, 1, 1–12. Hart, B. M., Reynolds, N. J., Baer, D. M., Brawley, E. R., & Harris, F. R. (1968). Effect of contingent and noncontingent social reinforcement on the cooperative play of a preschool child. Journal of Applied Behavior Analysis, 1, 73–76. Horner, R., & Day, H. (1991). The effects of response efficiency on functionally equivalent competing behaviors. Journal of Applied Behavior Analysis, 24, 719–732. Iwata, B. A., Dorsey, M. F., Slifer, K. J., Bauman, K. E., & Richman, G. S. (1982). Toward a functional analysis of self-injury. Analysis and Intervention in Developmental Disabilities, 2, 3–20. Iwata, B. A., Vollmer, T. R., & Zarcone, J. H. (1990). The experimental (functional) analysis of behavior disorders: Methodology, applications, and limitations. In A. C. Repp & N. N. Singh (Eds.), Current perspectives in nonaversive and aversive interventions with developmentally disabled persons (pp. 301–330). Sycamore, IL: Sycamore Publishing. Kazdin, A. E. (1977). Assessing the clinical or applied importance of behavior change through social validation. Behavior Modification, 1, 127–452. Kazdin, A. E. (1982). Single-case research designs: Methods for clinical and applied settings. New York, NY: Oxford University Press. Kazdin, A. E., & Matson, J. L. (1981). Social validation in mental retardation. Applied Research in Mental Retardation, 2, 34–51. Lalli, J. S., Browder, D. M., Mace, F. C., & Brown, D. K. (1993). Teacher use of descriptive analysis data to improve interventions to decrease students’ problem behaviors. Journal of Applied Behavior Analysis, 26, 227–238. Lerman, D. C., & Iwata, B. A. (1993). Descriptive and experimental analysis of variables maintaining self-injurious behavior. Journal of Applied Behavior Analysis, 26, 293–319. Madsen, C. H., Jr., Becker, W. C., & Thomas, D. R. (1968). Rules, praise, and ignoring: Elements of elementary classroom control. Journal of Applied Behavior Analysis, 1, 139–150. Martin, G. L., & Pear, J. (2007). Behavior modification: What it is and how to do it (8th ed.). Upper Saddle River, NJ: Pearson. Matson, J. L., Esveldt-Dawson, K., & Kazdin A. E. (1983). Validation of methods for assessing social skills in children. Journal of Clinical Psychology, 12, 174–180. Miltenberger, R. (2004). Behavior modification: Principles and procedures (3rd ed.). Pacific Grove, CA: Wadsworth.

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O’Leary, K. D., Becker, W. C., Evans, M. B., & Saudargas, R. A. (1969). A token reinforcement program in a public school: A replication and systematic analysis. Journal of Applied Behavior Analysis, 2, 3–13. Phillips, E. L. (1968). Achievement place: Token reinforcement procedures in a home-style rehabilitation setting for “pre-delinquent” boys. Journal of Applied Behavior Analysis, 1, 213–223. Repp, A. C., Felce, D., & Barton, L. E. (1988). Basing the treatment of stereotypic and self- injurious behavior on hypotheses of their causes. Journal of Applied Behavior Analysis, 21, 281–289. Rolider, A. (2003, September). The use of antecedent analysis driven intervention to treat complex anti-social behavior among children in school settings. Paper presented at the meeting of the Florida Association for Behavior Analysis, St. Petersburg Beach, FL. Rolider, A., & Axelrod, S. (2000). Teaching self-control to children through trigger analysis. Austin, TX: Pro-Ed. Rolider, N. U., Iwata, B. A., & Camp, E. M. (2006, September). Functional analysis of low-rate problem behavior. Paper presented at the 26th annual meeting of the Florida Association for Behavior Analysis, Daytona Beach, FL. Sailor, W., Guess, D., Rutherford, G., & Baer, D. M. (1968). Control of tantrum behavior by operant techniques during experimental verbal training. Journal of Applied Behavior Analysis, 1, 237–243. Schmidt, G. W., & Ulrich, R. E. (1969). Effects of group contingent events on classroom noise. Journal of Applied Behavior Analysis, 2, 171–179. Schutte, R. C., & Hopkins, B. L. (1970). The effects of teacher attention on following instructions in a kindergarten class. Journal of Applied Behavior Analysis, 3, 117–122. Steege, M. W., Wacker, D. P., Berg, W. K., Cigrand, K. K., & Cooper, L. J. (1989). The use of behavioral assessment to prescribe and evaluate treatments for severely handicapped children. Journal of Applied Behavior Analysis, 22, 23–33. Thomas, D. R., Becker, W. C., & Armstrong, M. (1968). Production and elimination of disruptive classroom behavior by systematically varying teacher’s behavior. Journal of Applied Behavior Analysis, 1, 35–45. Touchette, P. E., MacDonald, R. F., & Langer, S. W. (1985). A scatter plot for identifying stimulus control of problem behavior. Journal of Applied Behavior Analysis, 18, 343–351. Wahler, R. G. (1969). Setting generality: Some specific and general effects of child behavior therapy. Journal of Applied Behavior Analysis, 2, 239–246. Walker, H. M., & Buckley, N. K. (1972). Programming generalization and maintenance of treatment effects across time and across settings. Journal of Applied Behavior Analysis, 5, 209–224. Ward, M. H., & Baker, B. L. (1968). Reinforcement therapy in the classroom. Journal of Applied Behavior Analysis, 1, 323–328. Zeilberger, J., Sampen, S. E., & Sloane, H. N. (1968). Modification of a child’s problem behavior in the home with the mother as therapist. Journal of Applied Behavior Analysis, 1, 47–53. Zimmerman, E. H., Zimmerman, J., & Russell, C. D. (1969). Differential effects of token reinforcement on instruction—following behavior in retarded students instructed as a group. Journal of Applied Behavior Analysis, 2, 101–112.

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3The Cipani Behavioral Classification System

Objectives

• Students will be able to identify the four major diagnostic categories of problem behavior, and define each in terms of the establishing operation (EO) and functional relationship between behavior and its relevant abolishing operation (AO)

• Students will be able to identify the two Direct Access (DA) functions, and define each in terms of the EO, and functional relationship between behavior and its relevant AO

• Students will be able to identify the three Socially Mediated Access (SMA) functions, and define each in terms of the EO, and functional relationship between behavior and its relevant AO

• Students will be able to identify the four Direct Escape (DE) functions, and define each in terms of the EO, and functional relationship between behavior and its relevant AO

• Students will be able to identify the four Socially Mediated Escape (SME) functions, and define each in terms of the EO, and functional relationship between behavior and its relevant AO

• Students will be able to identify the factors involved in deciding the function and diagnostic category of problem behavior, that is, reliable relation between problem behavior and relevant outcome under a given EO, as well as the efficiency of such behaviors relative to other behaviors in producing such an outcome

• Students will be able to delineate how a given topography or form of behavior can be multi-functional

Chapter 3 Behavior Analysis Certification Board (BACB) Task List

4th edition 5th edition • I-05 Organize, analyze, and interpret

observed data

• I-06 Make recommendations regarding behaviors that must be established, maintained, increased, or decreased

• I-02 Define environmental variables in observable and measurable terms

• F-6 Describe the common functions of problem behavior.

• F-9 Interpret functional assessment data.

92 Functional Behavioral Assessment, Diagnosis, and Treatment

This chapter presents a function-based diagnostic classification system for target problem behaviors: The Cipani Behavioral Classification System (BCS). There are four major categories in this system, previously delineated in this text in Chapter 1 and historically (Cipani, 1990, 1994; Cipani & Cipani, 2017; Cipani & Schock, 2007, 2011). These are: (a) Direct Access (DA) 1.0, (b) Socially Mediated Access (SMA) 2.0, (c) Direct Escape (DE) 1.0, and (d) Socially Mediated Escape (SME) 4.0. The Cipani BCS delineates 13 different classifications of behavioral functions under these four major functional classification categories. Each of the 13 individual categories contain either a different behavioral function under a specified establishing operation and/or a different manner in which such a function is produced (direct vs. socially mediated).

The Cipani BCS is a classification system for behavioral functions; it does not categorize forms of behavior or “symptoms.” How is a function-based BCS differ from a more traditional classification system for problem behaviors? The following section identifies the basic characteristics of a function-based classification system.

WHAT IS A FUNCTION-BASED CLASSIFICATION SYSTEM? The characteristics of a function-based diagnostic classification system are the following (Cipani, 1994):

ll Diagnosis of behavior problem characteristics, not child characteristics ll Prescriptive differential treatment derived from a differential diagnosis ll Assessment data collected provides information on context variables, not just rate of

behavior ll Assessment phase concludes with diagnosis phase, in which a function-based category

is selected that best fits the problem behavior’s putative function under the specific EO

Diagnose Behavior, Not Client A function-based diagnostic classification system examines the contextual nature of the problem behavior. It does not presume that the exhibition of behavior is driven by characteristics inherent in the client or child. This sharply contrasts with the current psychiatric approach to diagnosing client behavior (e.g., Diagnostic and Statistical Manual of Mental Disorders [5th ed.; DSM-5]). In a function-based diagnostic classification system, the form of the behavior (in many cases) does not dictate a particular function.

Let us say you have three different children with whom you are involved as a behavioral consultant. Each child engages in a topographically (form) different set of target behaviors. In the traditional psychiatric diagnostic system, each child may receive a different diagnosis because the form of the problem behaviors is different. Because the behaviors or symptoms are different, their presumed cause is assumed to be different. In contrast, a function-based classification of the problem behaviors may reveal that the problem behaviors exhibited by these three children are similar in function, even though topographically dissimilar. Therefore, the classification of these behaviors function using the Cipani BCS could be the same. Using this hypothetical example, let us presume that the functional behavioral assessment obtained data that indicates that all three children’s behavior produces the same reinforcer (i.e., access to tangible reinforcers such as preferred activities). Hence, the function-based diagnosis for all three sets of problems might be subsumed in the same major category. Therefore, despite the obvious individual differences between these children, the prescription for behavior- analytic treatment for this problem area will be similar in composition.

Prescriptive Differential Treatment As just alluded to, a function-based diagnostic classification system also has implications for differential prescriptive treatment. The behavioral intervention designed takes into consideration the function of the problem behavior(s). It is the case that different topographies

3 The Cipani Behavioral Classification System 93

of behavior displayed by a given client can produce the same behavioral contingency if their function is the same. Here is an example.

A child diagnosed with a DSM-5 criteria of Oppositional Defiant Disorder is referred for a number of behavior problems. These problem behaviors include aggressive behavior toward residential staff, noncompliance, and running away from the facility. Aggression, noncompliance, and running away are topographically dissimilar behaviors. Does that mean that different behavioral contingencies should be invoked, depending on which behavior is exhibited at a particular time? Not in the least! If all three behaviors are found to serve the same environmental function, the treatment program would specify the same contingency across the occurrence of any of these behaviors. In other words, irrespective of which behavior occurs, the contingency it would produce (according to the functional treatment plan) would be the same. However, if noncompliance and running away serve a different function than the child’s aggressive behavior, there would be one treatment contingency for aggression and a different contingency for the other behaviors. The specifics of the behavioral treatment are driven by the function of behavior, not by the traditional diagnosis (such is actually irrelevant for functional treatment).

The same behavioral intervention would also apply if different clients or students engage in different forms of problem behaviors, but such behaviors serve the same function. Here is an illustrative example. A child named Susanna, diagnosed with conduct disorder, hits the teacher. A different child named Billy, diagnosed with oppositional defiant disorder, throws a tantrum during class and refuses to follow even simple directions. A third child, Raul, who is diagnosed with attention deficit hyperactivity disorder (ADHD), cries and throws a tantrum when he is prevented from running out of the classroom. Professionals who use a traditional diagnostic classification system presume that each of these three children exhibit different types of behaviors because of their different diagnostic classification. Susanna hits her teacher (and others) because of her affliction with conduct disorders. Billy throws a tantrum because he has oppositional defiant disorder. Raul cries and throws a tantrum because he is impulsive and is incapable of delaying gratification because of his ADHD. If there are three different disorders, should there not be three different treatments, that is, one for ADHD, one for conduct disorders, and so on? Our answer: Not if the different types of behaviors serve the same function (Cipani, 2014)!

Let us say that Raul’s tantrum behaviors and Susanna’s hitting behavior occur when they are denied access to a preferred activity. Both problem behaviors often result in getting the desired activity for each child. Given the same function, the behavioral treatment would be the same. If Billy’s topographically dissimilar problem behaviors are found to produce escape from the task, then the treatment would be designed that addresses that function. But it would be different because of the different function involved (i.e., access vs. escape), not the hypothesized mental disorder! Research studies in applied behavior analysis have failed to demonstrate that certain behavioral procedures work only for children with conduct disorder, or oppositional defiant disorder, and not for those with ADHD, and vice versa.1

In summary, classifying problem behaviors according to environmental function does make a crucial difference in the design of a functional behavioral treatment. In contrast, differential diagnosis using the traditional psychiatric Diagnostic and Statistical Manual of Mental Disorders does not prove fruitful in determining functional behavioral treatments based on syndromes of behaviors.

Assess Context Variables It should now be clear that a useful Functional Behavioral Assessment is concerned with more than just determining the rate of the target behavior. Assessment is driven by the need to determine the environmental factors that are present when the problem behavior occurs, that is, the social and physical environmental context. The effects of both antecedent and consequent conditions of the problem behavior need to be considered. Understanding the role of the client’s antecedent motivational condition at the time makes for a clearer picture of why certain consequent events function as reinforcers at those times. Understanding how certain people may be discriminative for such functions is also important (i.e., socially mediated functions).

94 Functional Behavioral Assessment, Diagnosis, and Treatment

Assessment Phase Concludes With a Differential Diagnosis Phase In the early development of the field of applied behavior analysis, the design of behavioral treatments often did not include a diagnostic phase. The collection of behavioral data often would lead directly to the formulation of a behavioral treatment regimen. In part, this occurred because the word diagnosis was associated with the mental health diagnostic system, which proved useless in the design of behavioral treatments. Given the lack of utility of a traditional diagnosis in prescribing functional behavioral treatments, many early behavior therapists/ behavior analysts have often worked with only two stages of service (i.e., assessment phase and subsequent design of treatment).

We believe that the Cipani BCS serves an important intermediate step. Such an intermediate phase between assessment and intervention would provide for a more guided and deliberate approach to behavioral treatment selection.

WHAT IS THE UTILITY OF A FUNCTION-BASED DIAGNOSTIC CLASSIFICATION SYSTEM? For people naive to behavior-analytic formulations, it may appear that one simply identifies a consequence for a selected target behavior. The selected consequence should be capable of ameliorating the level of the target behavior problem when applied as a contingency. Therefore, the only technical skill needed is to pinpoint the referred problem in observable terms and follow it with an effective consequence. For example, if a referred client is disruptive in an enclave-work environment, first one defines the disruptive behavior in observable terms. Then the professional identifies a consequence to follow the target behavior and specifies the treatment contingency. If this contingency does not work, the professional would select another consequence and design another behavioral treatment contingency.

GOT CONTEXT DATA?

I was involved in a case consultation years ago where a student who was attending a nonpublic school for emotionally disturbed children was being discussed at an interdisciplinary team meeting. Both school and mental health professionals were in attendance at this meeting. Although no actual behavioral assessment data were reported on specific target behaviors, the school and residential staff indicated that his behavior had worsened. They ascribed it to a litany of possible reasons. The reasons ranged from wrong diagnosis (e.g., “I don’t believe he is schizophrenic. I think he is bipolar!”) to blaming his dysfunctional family and his home visits. About 45 minutes went by without any pertinent discussion about specific target behaviors in the classroom. As the meeting was winding down, one of the teachers asked, “OK, what do we do when he acts up?” Somebody volunteered what appeared to be a solution, “Let’s use time-out.” Why was time- out being recommended? Was it important to comprehend that he was from a dysfunctional family, according to some experts? Are students who come from dysfunctional families best treated with time-out? Was it because time-out works best with manic-depressive children (but not, apparently, schizophrenia)? Nothing in the prior discussion had any relation to discussing the behavioral reasons for this proposed treatment. Nor was the rate of target behaviors presented. What was also missing was an analysis of the context under which these target behaviors occur. Further assessment of the contextual nature of the behavioral problems was required.

3 The Cipani Behavioral Classification System 95

Functional behavior-analytic treatment stems from hypotheses about the function or purpose of the target behavior. These hypotheses (classifications or categories of function) are generated from the collection and examination of functional behavioral assessment data. A function-based diagnostic classification of the problem behavior results from the clinician reviewing the information gathered during the functional behavioral assessment process. Such a process is analogous to procedures used in other science-based fields.

For example, in medicine, during an office visit, the physician gathers information about your current medical condition by asking you a series of questions, called a “diagnostic interview.” She or he then obtains other information, possibly from a physical examination as well as individual tests run on medical equipment. The physician then analyzes all the data obtained relevant to your condition and hypothesizes about the cause of your current medical problem. The physician then makes a differential diagnosis. This diagnosis subsequently allows the physician to prescribe a treatment based on that diagnosis. This treatment prescription makes “good sense” given this diagnosis. The treatment for a diagnosis of flu is different from a treatment prescription for a diagnosis of whooping cough. We believe it is just as important in many circumstances to determine the function of the problem behavior to ensure that the behavioral treatment being prescribed is functionally related to the problem behavior.

The remaining text in this chapter will delineate the 13 functions in the Cipani BCS (see Table 3.1) and provide examples of each classification function. For diagnostic criteria for each of these classification categories for use in school settings, the reader is enjoined to read Cipani and Cipani’s (2017) diagnostic manual for the Cipani BCS.

THE CIPANI BCS Cipani (1990, 1994) previously delineated four major diagnostic categories for classifying the environmental function of problem behaviors. The previous editions of this text utilized the same framework in the delineation of the function-based classification system (Cipani & Schock, 2007, 2011).

The following major category functions constitute this classification system:

(1.0) Direct Access (2.0) Socially Mediated Access (3.0) Direct Escape (4.0) Socially Mediated Escape

Within each major category, subcategories are offered. Each subcategory contains the basic characteristics inherent in the major category. The subcategories within each major category are:

ll DA 1.0 Functions l° DA 1.1: Immediate Sensory Stimuli (specify type and location of stimulation) l° DA 1.2: Tangible Reinforcers (specify tangible or class of tangible accessed)

ll SMA 2.0 Functions l° SMA 2.1: Adult Attention (specify which adults/staff) l° SMA 2.2: Peer Attention (specify which peers) l° SMA 2.3: Tangible Reinforcers (specify tangible or class of tangible accessed)

ll DE 3.0 Functions l° DE 3.1: Unpleasant Social Situations (specify situation[s]) l° DE 3.2: Lengthy Tasks/Chores/Assignments (specify length of task) l° DE 3.3: Difficult Tasks/Chores/Assignments (specify task that is difficult) l° DE 3.4: Aversive Physical Stimuli/Event (specify aversive physical stimulus)

96 Functional Behavioral Assessment, Diagnosis, and Treatment

ll SME 4.0 functions l° SME 4.1: Unpleasant Social Situations (specify situation[s]) l° SME 4.2: Lengthy Tasks/Chores/Assignments (specify length of task) l° SME 4.3: Difficult Tasks/Chores/Assignments (specify task that is difficult) l° SME 4.4: Aversive Physical Stimuli/Event (specify aversive physical stimulus)

Category: DA 1.0 Given a deprivation EO, the abolishing operation (i.e., delivery of positive reinforcer) occurs directly through the problem behavior or at the end of a chain of behaviors. In much of the professional literature, this category of behaviors has been referred to as automatic reinforcement (Vaughn & Michael, 1982). Our approach is slightly different from the currently in vogue use of the term automatic reinforcement. The use of the term direct access (and the latter term, direct escape) removes some of the possible misinterpretation of the term automatic. It borrows such terminology from Skinner’s verbal behavioral writings in describing verbal and nonverbal behavior (Skinner, 1957; Vargas, 1988).

We believe there is an advantage to the use of the term direct, in contrast to automatic reinforcement. Using the term direct is defined as behavior that contacts the nonsocial contingency (i.e., physical environment) directly, within a 0.5-second time interval. In other words, the reinforcing event occurs within 0.5 second of the terminal response occurring. If a behavior is maintained by an event that occurs subsequent to this time frame, it is probably not in this category. Further, not all DA functions involve stereotypic behaviors that produce sensory reinforcement as the maintaining contingency (see subcategory 1.2).

There are two subcategories serving DA functions: DA 1.1 Immediate Sensory Stimuli and DA 1.2 Tangible Reinforcers.

DA 1.1: Immediate Sensory Stimuli. Probably one of the greatest advancements in treating difficult problem behaviors exhibited by persons with severe disabilities, such as stereotypic behavior, is the understanding and demonstration that such behaviors may not be socially mediated (Caudery, Iwata, & Pace, 1990; Iwata, Dorsey, Slifer, Bauman, & Richman, 1982; Mason & Iwata, 1990). Problem behaviors in this category produce immediately (often within 0.5 second of terminal response) the sensory event that maintains such behavior. For example, persons who engage in frequent repetitive movements such as hand flapping often do so because of the sensory result such repetitive behaviors produce. Flapping their hands in a certain fashion produces a kinesthetic result that automatically creates its own built-in reinforcer.

Here is another example. Try rocking back and forth in a chair, and note the rhythm produced. Such a chain of behaviors produces a built-in sensory event. This built-in event can function as a reinforcer for the “rocking in the chair” behavior. Such an automatically produced result becomes more desired by persons who cannot create many forms of sensory stimulation due to their cognitive impairments. In contrast, nonhandicapped people are able

TABLE 3.1 n ANALYSIS OF DIRECT ACCESS FUNCTIONS: STEREOTYPIC BEHAVIOR

Establishing Operation (EO)

Behavior Abolishing Operation (direct)

Future Probability of Behavior Given EO

Relative deprivation of sensory event

Engages in specific stereotypic behavior

Produced immediately, reduces deprivation state

More likely

3 The Cipani Behavioral Classification System 97

to watch TV, read a book, listen to music, go on swings, and engage in other solitary activities on occasion. But for nonhandicaped people, occasionally engaging in such activities does not consume one’s entire purpose for the day. However, for persons with disabilities, such stereotypic behavior pervades the entire day and conflicts with alternate essential daily activities and behaviors.

Table DE 3.1 depicts the relationship between the sensory event being in a relative deprivation state (see first column A, Establishing Operation) and the occurrence of the self-stimulatory behavior (second column). Note that the maintaining contingency or abolishing operation is the direct result the behavior produces (third column). Any effect of the behavior on the social environment is inconsequential. The staff or teacher may admonish the client or child after the behavior. However, such a social event is not the purpose of this behavior, even though it may be a reliable contingency of the behavior. It is the sensory result of the stereotypic behavior that will make such a form of behavior occur again when a sufficient state of deprivation is present. Sensory events that can be produced directly through various behaviors can include auditory, visual, tactile, gustatory, and olfactory stimuli.

Many ritualistic (stereotypic) behaviors appear to produce their own immediate kinesthetic reinforcer. Such behaviors often occur independent of the reaction from the social environment. Addictive behaviors, such as smoking and drinking, may also be maintained as a result of their immediate sensory effect. Although this may not describe how such behaviors were developed in the first place, it can explain why such behaviors are still maintained even when the original purpose (EO) is no longer operable. Certainly, for smokers at certain age ranges, social reinforcement and peer acceptance of smoking has diminished tremendously in the last several decades. Yet some people continue to smoke despite the absence of peer reinforcement (and known health risks). Why? For smokers who began the habit years ago, the act of smoking often has its own built-in reinforcer. Table 3.2 provides some questions to consider when entertaining DA to immediate sensory stimuli as a hypothesis.

In Question 1, you should consider whether a one-to-one relationship exists between the behavior and the sensory event. What is the desired sensory event (Question 2)? In some cases, it may be easy to determine the probable sensory reinforcer. For example, someone who sings in the shower is probably reinforced with the auditory result of vocal production in an enclosed area. However, in other cases, it may be difficult to discern what automatic sensory event is the reinforcer. If necessary, an experimental analysis that presents conditions where the sensory effect is ameliorated or eliminated may be the most effective manner of determining such.

www.springerpub.com/fbadt

SMA or DA lecture

ASSIGNMENT

After reviewing the narrated PowerPoint lecture entitled, “Is It SMA or DA?” delineate the test procedures that can be used to isolate the function of behav- iors that appear to be DA, but could also be SMA functions.

For the select target behavior of hair twirling, include in your paper the fol- lowing (in this order):

1. Delineate the procedures for the test condition involving DA function (behavior that produces what contingency).

2. Delineate the procedures for the test condition involving SMA function (behavior that produces what contingency).

3. Generate hypothetical data in a table or graph that displays data for three session for each test condition (six total sessions) in a multielement design, Then explain in text what the results indicate, that is, what function seems verified by the hypothetical data.

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Question 3 addresses the evidence that points to a hypothesis of DA to sensory reinforcement. If the problem behavior is sensory reinforced, it will often occur across most contexts (possibly excluding contexts where punishing consequences have affected the rate). For many clients who engage in self-stimulatory behavior, they engage in such behaviors irrespective of context. If a client engaged in hand flapping only in the context of certain staff, and not others, such a pattern of stereotypic behavior would seem to point to an SMA function. Perhaps some examples of subcategory DA 1.1: Immediate Sensory Stimuli will clarify DA functions representative of this category.

Talking Is Good? I observed a client at a residential facility for persons with disabilities talking loudly to herself while pushing a laundry cart across a parking lot. I looked around and did not see any staff or other people. How can anyone talk or engage in conversation when there is not an audience with which to interact? A traditionally trained mental health professional may surmise that such vocal behavior is directed at an imaginary person. They contend that the client is carrying on a conversation with someone in her mind, who is responding back to her. Although one cannot see what is transpiring inside her cortex, these professionals assume the existence of such on the basis of the carried on conversation. Hence, the client might be hypothesized to be experiencing auditory hallucinations during those incidents.

Is there an alternate explanation? Can such a behavior be maintained in the absence of an audience? Vocal discourse may produce its own reinforcer, that is, auditory (hearing one’s voice) or kinesthetic effect on vocal cords. Certainly, this phenomenon is present in infants who babble for long periods, testing out their newfound ability to generate a sensory effect by vocal production. As I observed this person pushing the laundry cart by herself, that certainly seemed a plausible hypothesis.

How can one determine whether sensory reinforcement is maintaining the client’s vocal behavior? If this behavior occurs when staff are not physically present, and such behavior does not result in their subsequent attention, its function does not seem to be socially mediated. In contrast, if particular staff attend to her in certain ways upon hearing her talking to herself, then subcategory DA 1.1 is probably not an accurate diagnosis for this client. Further evidence of a socially mediated function would be the inability of other behaviors that are in the client’s repertoire to get staff or adult attention when it is available.

Failure to diagnose this as a behavior maintained by sensory reinforcement when indicated may lead to the design of an ineffective treatment strategy. If the vocal discourse produces a DA function, a treatment strategy that involved “ignoring the behavior” would have no effect at all on the rate of this behavior. Intervention of problem behaviors within this category should be aimed at “weaning her off ” of sensory reinforcement or bringing it under control in certain contexts that are not as public (see Chapter 4).

The Voices Make Me Laugh. Here is a similar real-life circumstance. A man, for no apparent reason, would occasionally just burst out laughing as if he had just heard the funniest joke in the world. During an intake at a psychiatric center, he told the professional conducting the assessment that he heard voices in his head. These voices would tell him

TABLE 3.2 n QUESTIONS TO CONSIDER

1. Is there a reliable (every single occurrence) relation between the specific behavior and immediate production of the hypothesized desired sensory event? What is the specific form of the behavior?

2. What seems to be the auditory, visual, tactile, kinesthetic, or gustatory sensation that maintains contingency?

3. What evidence supports the hypothesis that a sensory event is the maintaining contingency? Does this behavior occur across a variety of situations when the client is in a deprived state relative to the sensory event? In other words, does the client engage in this behavior (usually) irrespective of context? Will it occur in the absence of people?

3 The Cipani Behavioral Classification System 99

funny stories and jokes. As a result, this individual was diagnosed with schizophrenia, with “hearing voices” a prime reason for such a diagnosis.

Does he really hear voices? Many mental health professionals would say “yes,” explaining that such voices are a product of his hypothesized neuro-chemical deficits. His mind makes him actually hear voices. Of course, no one can absolutely posit that he does hear voices because the only person who can accurately determine such is this man. The only data regarding this phenomenon is his self-report, which has obvious problems with validity. Is it possible that such a behavior, laughing independent of social input, could be a behavior maintained by reinforcement? As he became a client at the Community Re-Entry Project at the University of the Pacific, Keven Schock and his colleagues would have to answer that question.

How would an analysis of environmental function proceed with such a behavior? First, it was not their intention to actually try to figure out if some internal auditory stimuli were present (currently impossible to deduce). The primary goal was to determine whether the behavior could be socially mediated. To rule out staff (or peer) attention as a possible maintaining contingency, data was collected on the laughing incidents under two conditions: (a) how often he burst out laughing when there were people close by and (b) how often he laughed when he was too far away from people for them to notice him laughing and interact with him. If adult attention were maintaining such a behavior, one would expect to see him engage in this laughter when he was near people, but not involved in social interactions. In addition, if he did engage in such a behavior when away from people, such behavior would recruit their attention.

Therefore, they examined two related sets of data under each condition. First, they examined the number of times he laughed and the total number of minutes he laughed. They found that in this person’s case, if he was left alone and not interrupted, the probability of this behavior was far greater than in the presence of people. In addition, it was noted that such laughter was not frequently resulting in staff attention. In fact, he was perfectly content to be alone while bursting out into laughter. Given this information, it seemed unlikely that his outbursts of laughter were maintained by social attention. This caused them to suspect that for this person, laughing itself was reinforcing.

Could laughing without someone providing a comical situation be a behavior that produces reinforcement in the absence of people? It is similar to the process that many of us go through related to singing in the shower or talking to ourselves. When we sing in the shower, there is generally no one else present to provide attention. Singing in the shower also does not terminate or avoid some aversive situation. Further, most of us would not say that a voice in our head told us to sing in the shower. Therefore, we are left with the only possible function being self-stimulation. So whether it is laughing, singing, or talking to oneself, try to discriminate where you do these self-stimulatory behaviors, but once you are alone, go ahead, I will not tell!

Time-Out Does Not Work? A landmark study in the field of applied behavior analysis involved a study of the effectiveness of time-out procedures with stereotypic behavior (Solnick, Rincover, & Peterson, 1977). It provided evidence that some behaviors produce their own reinforcer. A 6-year-old girl with autism engaged in tantrum behavior. The initial assessment did not reveal the function of this behavior. (Remember this was 1977, and the state of practice and research was not yet investigating behavioral function of target problems.) The researchers tested the effectiveness of time-out on tantrum behavior during

DISCUSSION QUESTION 3A What would you surmise would be the conditions under which laughing at inappropriate times would be maintained by social attention? How would you conduct a trigger analysis of such an antecedent EO (i.e., lack of attention)?

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instructional sessions. In contrast to a baseline, the results were surprising. Time-out did not decrease tantrum behavior. How could that be?

The researchers noted that when this girl was sent to time-out, she engaged in stereotypic behavior, which consisted of weaving her fingers in a pattern. Such behavior was obviously discouraged during instruction. Hence, time-out was the perfect opportunity to engage in such a behavior without impediment. Solnick et al. (1977) then conducted a second study to empirically demonstrate why time-out did not produce a change in tantrum behavior. In the follow-up study, time-out was still a contingency for this girl’s tantrum behavior during instruction. However, the efficacy of time-out was investigated under two different conditions. In one condition, the stereotypic behavior occurring in time-out was left unfettered. In a second experimental condition, such behavior was prevented by immediately restraining her hands upon the initial hand weave. Therefore, in this condition, the hypothesized sensory effect desired was prevented.

The results proved an important point. If time-out resulted in free access to stereotypic behavior (and sensory reinforcement), then the time-out procedure was ineffective at reducing tantrum behavior. However, when such a sensory effect was eliminated, contingent time-outs reduced tantrum behavior. In 1977, these researchers uncovered the possibility that stereotypic behavior was probably automatically reinforced via its sensory effects in many clients with such a problem.

Pica: The Classic Case of Sensory Reinforcement. A male client sticks inedible things in his mouth and gnaws on them (commonly called pica). Many naive personnel may ascribe such behavior of a client to some form of social attention. When asked why the client does that, a staff person responds, “He knows that it upsets me in that I have to go and get it out of his mouth. He likes to see me work.” Putting aside for the moment the employee’s work habits, the purpose of the behavior often has nothing to do with staff. One would not ascribe a baby’s gnawing or mouthing a particular object as a behavior intended to upset his mother or care provider. The same may hold true in this case.

If pica behavior in a particular client is producing its own sensory reinforcer, what could that possibly be? Mouthing of inedible objects produces oral stimulation (probably similar to gum chewing for some people), a sensory event that is the direct result of the behavior. If pica (in this particular case) is serving a DA function, then oral sensory stimulation might be the reinforcer. One should see that such behavior occurs at a consistent rate when left unabated. Attempts to stop it often are met with the client finding contexts in which access to the reinforcer is “under the radar” of the staff. In other words, the client becomes sneaky and stealthy in engaging in this behavior.

In some cases, pica may be socially mediated. However, the form of the behavior is of such a nature that sensory reinforcement should be initially considered when reviewing behavioral assessment data. To rule out social mediation of this behavior, examine the relationship between engaging in pica and SMA to attention via a trigger analysis. Concurrently, also examine the possibility that pica incidents produce SME from relatively aversive events. For example, when the client engages in pica, is the aversive event removed? Is pica a more efficient behavior in getting such a result than other behaviors?

I Like to Bang Against Plexiglas. A hypothetical male adult client with developmental disabilities slaps his hand against the Plexiglas window. Data reveal that this behavior occurs multiple times a day, and he targets the Plexiglas window rather than the stucco wall next to the window. Staff may try to keep him away from the window, but he continues to seek opportunities when they are not as vigilant. When they are not looking, he runs to the Plexiglas window and strikes it with open hand. Staff attribute this client’s destructive behavior toward property to the adult attention he receives upon its exhibition. The staff will scold him and redirect him back to his couch. They will often report, “He likes negative attention. We tell him to stop, but that seems to be what he thrives on, since he goes and does it again at every opportunity.”

If such were true, then removing attention would result in the extinction of window slapping from this client. However, removal of such staff attention does not decrease this daily pattern of behavior. In fact, it only seems to facilitate ad lib access to such and exacerbate the problem. Could it be that such behavior is maintained by the direct result

3 The Cipani Behavioral Classification System 101

it produces? When this client hits the window, a sound of some decibel level is produced. If such a sound is unique to hitting this particular Plexiglas window, it may be this sensory reinforcer is the controlling variable. Maybe it is not the sound that is created, but rather, it is the unique kinesthetic feel of hitting Plexiglas with one’s bare hand. Hitting the wall would not produce the same sensation, which explains why he targets the window. Either way, a desire for attention is not the “driving force.”

What About Kissing and Sex? Distinctive circumstances that fit this category are behaviors that result in sexual (sensory) excitation. Behaviors such as kissing, fondling, and the act of intercourse involve directly contacting a sensory event that follows such behaviors. The DA contingency function involves the behavior/action producing the putative desired reinforcer within a split second; for example, when the lips make contact, the sensory event is produced. This relationship may produce the maintaining contingency, under the relevant EO of deprivation of such stimulation (i.e., a sufficient state of deprivation is relative to each individual). If the functional reinforcer (maintaining contingency) is sensory excitation, such instances of behavior are best categorized as an immediate sensory stimuli DA function.

But such a sensory result is obviously rendered by another person. Why is such a behavior-environment relationship not considered a socially mediated function? In this behavior–reinforcer relationship, the stipulation that the behavior is maintained by its direct relationship with the reinforcer makes such instances a DA function. The other person is not delivering an event or activity that has no direct relationship to the behavior. For example, if upon a kiss, the other person gave the target individual a pizza, the kiss has an SMA function under the deprivation EO related to pizza access. You can say that this hypothetical person kisses someone to get a pizza when he or she wants one. But kissing at some length and intensity serves a DA function when the most powerful existing deprivation EO is a sexual sensory stimulation.

Of course, SMA functions with attendant EOs can also explain some/many incidents of such behavior when occurring under a social/sexual relationship. Someone’s attention and emotional affection can serve as reinforcers (as well as obtaining gifts, etc. as possible tangible by-products of a relationship), given the relevant EOs. Particularly with high school students (but certainly could apply to older persons as well), having a “boyfriend” or “girlfriend” can produce peer attention/approval and peer status. Therefore, in order to determine the function of a given act, (e.g., kissing someone), the relevant EO would have to be identified.

DA 1.2: Tangible Reinforcers. When you want a drink of juice, you may ask someone to get it for you if you are in his or her home. But when you are in your own home, you walk to the refrigerator, pull out the juice bottle, pour it in a cup, and drink. Such a chain of behaviors is reinforced, under the motivational condition of wanting juice (EO), by ingesting the liquid refreshment. For many people, DA to tangible reinforcers is available to them when they engage in a sequence of acceptable behaviors, such as walking to the refrigerator and retrieving a desired food or drink item. In contrast, some clients who reside in residential facilities with other people cannot simply go get something out of the refrigerator whenever they desire something. Facility staff persons may be under orders to prevent ad lib access to food and drink items by clients. Hence, access to such becomes restricted. As mentioned, simply walking to the refrigerator to get a food item is encumbered by staff, but the desire (deprivation EO) still remains in effect! Perhaps running to the refrigerator when staff are not in the immediate area may then develop as a more functional behavior. Subsequently, a referral is made for someone who runs in the facility and attempts to steal food.

DISCUSSION QUESTION 3B Describe the scenario under which such a behavior as hitting Plexiglas would be an SME function? What would staff have to do when he bangs Plexiglas?

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Table 3.3 illustrates the contextual conditions for DA 1.2: Tangible Reinforcer. This DA function is preceded by the existence of a sufficient state of deprivation with respect to an item, activity, or event (first column). This deprivation EO thereby establishes the item as valuable at that point in time. Therefore, whatever behavior(s) is capable of producing the desired item becomes more probable. With respect to this DA function, a chain of behaviors that can result in obtaining the desired item or activity fits this requirement better than other behaviors (next two columns).

Once the item is obtained to a sufficient degree or amount, the prior state of deprivation is abated and the value of the item diminishes at that point. The particular chain of behaviors therefore becomes functional under this deprivation EO and becomes more likely in the future. Note again that any social consequence that may follow this behavior is tangential and is not the maintaining variable or function. The staff may scold the child, place the child in time-out, or engage in other discipline practices. Such practices have nothing to do with the purpose of the behavior. Further, in light of the efficiency of the chain of behaviors to produce reinforcement, such attempts to “correct” the behavior may fail.

If a client wants a piece of chocolate cake and is told “not till after dinner,” pilfering a piece of cake undetected becomes an effective manner of getting cake. Do you have clients who eat their food at mealtime and then begin grabbing the food off their neighbor’s plates, sometimes undetected? If they are adept at pulling this off reliably, such a chain of stealth behaviors becomes strengthened while at the group mealtime. Do they do this for your “negative” attention? Probably not. Your comments regarding their behavior are tangential and inconsequential to the true purpose of this behavior. They would probably be elated if you would turn around and ignore them! They would then have a greater chance to devour a sufficient amount of someone else’s dinner without interruption.

Table 3.4 presents some questions to consider in evaluating a behavior as a DA 1.2: Tangible Reinforcer diagnosis. First, the target problem behavior must have a reliable and

TABLE 3.3 n ANALYSIS OF DIRECT REINFORCEMENT EFFECTS

Establishing Operation

Behavior Maintaining Contingency (AO)

Future Probability of Behavior Under MO

Relative deprivation of tangible item

Chain of behaviors occurs e.g., grabbing, taking item or activity unauthorized

Tangible item produced immediately at the end of the chain, abolishing deprivation state

More likely

AO, abolishing operation; MO, motivating operation.

TABLE 3.4 n QUESTIONS TO CONSIDER FOR A DA 1.2 DIAGNOSIS

1. Is there a reliable, somewhat frequent, direct relation between the problem behavior and getting a desired item or activity? Describe the chain of behaviors.

2. Are the target behaviors more likely to produce the desired items/activities than appropriate behaviors? Are other attempts to access these items or events thwarted? Are the DA problem behaviors thwarted? If so, how often is the client successful relative to other behaviors that may be socially mediated?

3. Does the behavior occur when there exists a sufficient state of deprivation for that client?

4. Are there any special contexts (e.g., during shopping trips, while at home) that make these behaviors more likely?

3 The Cipani Behavioral Classification System 103

frequent relation between the desired tangible reinforcer and its occurrence (Question 1). If  it is a chain of behaviors (often the case), it is the last response step in the chain that produces the tangible reinforcer.

In addition to the reliable relation between the problem behavior and direct production of reinforcer, you should note whether other behaviors are more or less successful in obtaining the desired event (Question 2). The ability of a chain of behaviors to directly produce the tangible reinforcer under sufficient motivational conditions determines the probability of such behaviors, especially when examining how successful (or not) other behaviors are. Question 3 involves examining the antecedent condition to determine if the relevant state of deprivation seems to exist at the time the behavior occurs. Question 4 attempts to discern if there is any special context for such behavior, such as shopping trips or other occasions where a special tangible reinforcer is available.

Breakfast Is Down the Corner. Stealing is a great example of a behavioral pattern that can be maintained by DA to the desired tangible items. It also is often maintained by social peer attention, as is often the case with juvenile delinquents. Knowing which motivating operation (MO) is in effect can lead to a more functionally derived treatment strategy. A foster family I was involved with had several children, all coming from the same mother. One of the boys (Roberto, who was 9 years old at the time) was stealing money and various things from family members as well as from classmates at school. This was apparently a behavioral pattern he picked up early in life when he was with his biological mother. I was told that when the children wanted breakfast, they were told (facsimile of conversation), “The mini-mart is down the street, get to it.” His biological mother felt her children should fend for themselves, hence his early exposure to shoplifting. Once this state of affairs was uncovered, they were removed from their mother. But you can imagine that with insufficient consequences for being caught, and continued practice, Roberto became quite adept at being a frequent usurper of other people’s possessions.

Prior to my involvement, the foster father had tried many strategies to deter stealing. These included pleading with him, discussing society’s prohibition against stealing, appealing to his better judgment, trying to induce guilt and shame over stealing others’ possessions, and grounding him. It would be essential to design a plan that made stealing items not functional (in terms of keeping items). Additionally, getting desired items should be addressed via appropriate channels. If the behavior is maintained because of the items it directly produces, then a program that addresses that function should designate an alternate venue for getting desired items. Reinforcing the absence of stealing would seem to be the way to go in this case.

The plan I came up with involved planting items around the house in conspicuous spots to monitor stealing. I called this the planted item technique, borrowed from researchers Switzer, Deal, and Bailey (1977). Each day the father would place several items, including money, in designated places (unannounced to Roberto). This allowed his father to systematically track stealing by checking each place.

Roberto was informed of the plan the night before it was to go into effect. If all the items remained in their place at the end of the day and there were no other reports of stealing, Roberto received $0.50 for the day. However, if something was missing, the punishing consequences involved the following: (a) return item(s) stolen, (b) lose the stipend amount for that day, and (c) pay a penalty equal to double the value of the item(s) taken. Note that this plan had consequences for stealing as well as for not stealing. I believe the father also threw in early bedtime as well.

As you can imagine, his rate of stealing went down. Stopping this behavior had a profound impact on Roberto’s relationship with both of his foster parents. Probably one of the nicest outcomes of changing Roberto’s behavior happened on one of my visits to the home. His foster mother reported to me an incident in which she was so particularly proud of him. Roberto had returned some planted money to her, saying he found it (planted item) and that she must have lost it. Now that is how you develop a moral compass, a conscience in a child who lacked an upbringing that instilled such values. About a year and a half later, Roberto was still reported to not have a problem with stealing.

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Food Scavenging! Some clients in residential and inpatient facilities have a target behavior listed on their habilitative plan as scavenging. In the case of students with severe disabilities, such may be listed on their individualized educational plan (IEP). Selecting items off the floor and placing them in one’s mouth is a chain of behaviors that can serve a DA function. The food ingestion would seem to be the terminal reinforcing event for the chain of behaviors involved in scavenging. Such scavenging may become more likely after people have finished eating. Again the form of the behavior may change over time as staff become more adept at preventing access to food on the floor by closer vigilance of clients. Successful retrieval of food on the floor may require a quick and stealthy performance to avoid staff detection.

The same behavioral phenomenon exists with some clients who ingest cigarette butts that are thrown on the floor or ground after being smoked. They scavenge areas looking for cigarette butts and will resist staff attempts to physically refrain them from picking up the cigarette butt off the floor. If you believe that this scavenging behavior is socially mediated, try ignoring such attempts to scavenge in a single test session of an in-vivo experiment.2 If the rate stays high or increases, you obviously have not removed the maintaining contingency. You may also receive a “thank you” from the client for allowing unrestricted access to the desired event.

Category: SMA 2.0 Problem behaviors that serve this type of access function obtain the reinforcer through the actions/behavior of another individual. Social attention and interaction from teachers, peers, staff, or parents are all examples of functions in this category. Obtaining preferred food items, toys, or activities can also be SMA functions if such are obtained through the behavior of another person (not directly as previous DA 1.2 category). Within this major category are the following subcategories: SMA 2.1: Adult/Staff Attention; SMA 2.2: Peer Attention; and SMA 2.3: Tangible Reinforcers.

ARE CERTAIN DISORDERS MORE LIKELY TO BE DIAGNOSED WITH SOCIALLY MEDIATED FUNCTIONS?

No, not to the extent that there is any empirical evidence supporting such a contention. For example, to say that persons with intermittent explosive disorder are more likely to have aggressive behavior that is functioning to access adult or peer attention is in opposition to the content of this book. The social environment of each individual determines how certain behaviors affect other people as well as the physical environment. One person with this disorder may yell and scream while at work. Other employees leave the person alone at these times. The function may be avoidance of social interaction at times when it is not desired. Unfortunately, frequent exhibition of such behavior will inevitably result in being fired (long-term consequence). In another person with the same psychiatric disorder, the function of verbal and sometimes physically aggressive behavior may be in the context of a spouse, for example, when the spouse talks on the phone to friends and does not pay enough attention to him or her. Such behavior may be maintained by recruiting desired attention.

The role of a traditional mental disorder diagnosis in a function-based diagnostic classification system is irrelevant at best. While such a diagnosis may be useful in other treatments such as medication, its utility in a behaviorally based system is nonessential. It could often be counterproductive if it sways professional personnel from examining behavioral function.

3 The Cipani Behavioral Classification System 105

SMA 2.1: Adult/Staff Attention. “He does it for my attention! He even likes negative attention.” Not all problem behaviors function to access attention, as some people would have us believe. But in some circumstances, it is true. Problem behaviors that successfully access teacher, parent, or care provider attention are strengthened when the child or client is in need of such attention. Concurrently, other behaviors in the child or client’s repertoire that are less effective or efficient in producing such desired events become weakened. For children, attention from parents, teachers, care providers, or staff at facilities can serve as the function for behavior (both appropriate and inappropriate) under a deprivation EO with respect to such attention. For clients in facilities, staff attention is sometimes the maintaining variable in target undesired behavior. A descriptive analysis for this subcategory is given in Table 3.5.

Table 3.5 illustrates that behaviors that serve this function occur when the EO for attention is great (column A). This sets up the conditions for the client to be “motivated” to obtain such (given someone who is discriminative for providing attention for some displayed behavior). The occurrence of the behavior (column B) at some frequency or duration produces the desired form of attention (column C), thus making it functional under those antecedent conditions.

The form of behavior that results in adult attention is determined by the specific social environment. For example, in one situation, a smile from a man may evoke eye contact and a smile back from an interested female walking past this man. However, the same smile from this man has no effect on another woman next to whom he sits down. Later on, the same behavior from this man results in a frown of disgust from a married woman in the restaurant. If the smile produces a fair number of acceptable social responses, this man is more likely to smile than exhibit other behaviors when seeking someone’s attention. As a side note, certain elements/stimuli of the social context may develop discriminative properties over this man’s behavior for someone’s attention over time. For example, he may learn to smile only when the female shows initial interest (i.e., makes eye contact with him).

Problem behaviors maintained by adult attention can take many forms, from innocuous minor behaviors such as giggling, to behaviors that cause great disruption, such as severe tantrums, aggression to others, and running away. For attention to be the function, the problem behavior should reliably produce teacher attention under the relevant deprivation EO, and this temporal relationship should be observed. For example, in the face of a child wanting attention, the problem behavior becomes more effective or efficient at getting the adult’s attention than other behaviors, either desirable or undesirable. Table 3.6 specifies factors to examine when considering an adult attention hypothesis.

TABLE 3.5 n ATTENTION FUNCTION

EO B Contingency (AO)

Absence of attention for a sufficient period of time

Behavior occurs (at some frequency and/or duration)

Adult attention (delivered in some form)

AO, abolishing operation; EO, establishing operation.

TABLE 3.6 n QUESTIONS TO CONSIDER FOR AN SMA 2.1 DIAGNOSIS

1. Is there a reliable, somewhat frequent relation, between the problem behavior and teacher, staff, or parent attention? What is the form of the behavior?

2. Are the target behaviors more likely to produce attention than other more acceptable behaviors?

3. Does the behavior occur in the absence of attention and a sufficient state of deprivation (relative) exists?

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An attention function involves a reliable relation between the problem behavior and access to desired attention (Question 1). Although the target problem behaviors may have to occur at some frequency and duration, such problem behaviors are more successful at getting attention than other more acceptable behaviors (Question 2). Further, the target problem behavior occurs in the absence of attention, where a sufficient state of deprivation exists (Question 3). Let us examine possible scenarios of problem behavior representative of this diagnostic category.

I Want Your Attention, NOW! A hypothetical student, Dolly, is referred for consultation as a result of whining and tantrum behavior in a primary elementary grade class. The teacher reports to you that this student is simply immature for her age. Dolly spends part of her day in general education and the remainder in a special education resource room. The general education teacher states that these tantrum behaviors can occur unexpectedly; “whenever Dolly is in a bad mood. You never know when she is in a bad mood!”

You schedule a 50-minute consultation visit and prepare to identify the context under which tantrum behaviors occur. Using direct observation and determining what EO seemed to be present at the time of the “tantrum incident,” you view the following in a session involving teacher lecture and independent seat work. Tantrum behavior did not occur during teacher-delivered instruction. Rather, it occurs during seat work. Dolly would work for a while without any problems. However, when tantrums did occur, the context seemed to involve the following. Dolly would raise her hand to obtain teacher attention. Unfortunately, such requests frequently go ignored for some period of time because the teacher is often working with someone else. Hand raising is not an effective or efficient manner to get the teacher’s attention at these times. This is not making a social judgment, but rather an empirical observation. This situation also leads to a strengthening of the EO for attention relative to other needs. Getting teacher attention becomes an even higher priority with Dolly when this happens. However, when Dolly hits her desk with her hands while concomitantly whining and complaining, the teacher first tells her to stop. However, shortly thereafter, the teacher comes to her desk to “find out what all the fuss is about.” With this offering of help by the teacher, Dolly then proceeds to calm down and begin her seatwork (and the teacher provides her help and encouragement).

When this student wants the teacher to come over to her, what are her options? Raise her hand? Selecting that option results in a longer protracted wait. Bang on the desk? That option produces faster results; hence, that form of behavior becomes strengthened under the conditions of wanting teacher attention.

In this case, there is another question one has to ask and answer. Why is teacher attention in some form of deprivation in the general education class, but not in the resource room (tantrum behaviors not reported to be a problem in this setting). Observation of the two classrooms will reveal the reason. You realize that in this student’s resource room there may be 6 to 11 children at any one time. Therefore, needing teacher attention is not as lengthy a wait as in the general education class. In the general education class, 25 other students have needs as well. Dolly’s access to teacher attention is markedly less. Hence she engages in behaviors that are hard to ignore, but unfortunately will result in her loss of placement in mainstream settings.

I Am on the Phone! How many times have you seen (or been the recipient of) a child screaming, “Mom, I need to talk to you!” while Mom is on the phone or engaged in conversation? Interrupting behaviors occur because they are more successful under those conditions than other more desirable behaviors. The child may tug on Mom’s shirt, but to no avail. However, a loud scream produces several responses from Mom. Let us look at a scenario depicting what transpires that makes screaming an adaptive response for this child when Mom is busy with someone else.

Child: Mom, I need you (in conversational tone while pulling on her shirt). Mom: Wait just a minute; I am on the phone with your sister. She is at the dentist. Child: (after several minutes go by): Mom, I need to get some juice. I am losing my

voice from lack of liquid.

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Parent: Hold on, I will only be another minute. Child: (several minutes go by, child screams): Well I will just get it myself. I have to do

everything myself. Nobody cares about me! Mom: OK, I am coming (and terminates conversation).

As you can see, the child escalates his or her demanding when minor forms of demands for Mom’s attention are not fruitful (which is very often the case with phone conversations). Ignoring these minor forms then makes the screaming bout at the end more likely, with Mom terminating the conversation shortly and attending to the child. The child’s level of screaming under conditions where attention is wanted has just been strengthened. Of course, many more scenarios similar to this play out over time to develop a reliable contingent relation between the form of screaming and accessing Mom’s attention.

A Pinch Here, a Pinch There. An adult male client with severe mental retardation who has no vocal speech would pinch people as they passed by him. It was easy for me to discern who this client was upon entering the building without anyone pointing him out. As I entered the building I could see him sitting at a table. Nothing striking there, right? Upon observation, adult staff at his day treatment program would near his table area and then move in a semicircle away from him in order to get to the other side. Now you know why it was easy to figure out who this client was without someone pointing him out.

Occasionally, even with staff winding a long arc around his area, he would be successful in pinching people. If someone got too close, he would dart out of his seat and pinch that person. Of course, new persons on the floor had to be warned about such a behavior in order to engage in the protocol for avoiding him. As you could imagine, this “imposed circle of avoidance” made attention even more desired from this client’s perspective. As staff became more successful at avoiding him, the rate of attention from staff became less and less. The more successful the staff persons were at avoiding him on a given day, the greater the deprivation EO became, making attention even more valuable.

To compound matters, staff members were instructed to engage in the following contingency upon being pinched by this client. They were to immediately say “No pinching,” and then proceed to his hand, shake it, and say, “This is what we are supposed to do.” The program designer probably thought that this would teach him how to initiate acceptable social interactions with staff. Instead of pinching, he would offer to shake hands. Wrong on that count. Let us examine all the behavioral contingencies in place for this client. When he simply sits in his seat, people avoid him so that he will not pinch. Nothing in the program design mentions to catch him when he is not pinching and prompt the acceptable behavior! But, when he does pinch, he gets some brief interaction with people in this correction procedure. Pinching successfully ensures him staff attention as the staff adhere to this program. Pinch away!

“I Will Kill Myself!” When someone in a mental health facility makes this statement, his or her environment is guaranteed to change. Protocol requires that a number of staff interactions, interviews, and assessments be conducted to determine the dangerousness of such a verbal statement. Such traditional assessments often revolve around determining whether the person is depressed to such a level that killing oneself is an option he or she might entertain. Of course, all instruments that could be used for committing suicide are made inaccessible. Staff members are intensely vigilant in these circumstances to ensure that such items are not attainable. Such efforts are certainly mandatory in the case of protecting life.

Could an analysis of behavioral function be of utility in separating out those persons whose life is in immediate danger from others? What possible behavioral function could such threats serve? Could such threats to kill oneself be under control of social reinforcers? If so, why would some people need to go to this extreme (stating they are going to kill themselves) to get such reinforcers? Although not discounting the possibility that some people obviously commit suicide because they feel (at that time) life may not be worth living, a functional evaluation of verbal statements may prove useful in designing treatment.

Let us take the case of someone who has just lost a spouse through an abrupt death. In a state of depression, the person contacts a mental health crisis center. Contingent upon saying

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that suicide is an option as a result of his or her grief, the person immediately interacts with many different professional people (e.g., doctors, nurses, social workers, front-line support staff, and therapists). In a time of need, these professional people are very supportive and caring, and the client possibly begins to reevaluate his or her life in new ways. As this person’s mental health is evaluated as improving, the client sees these people less and less over time. For some people that may not be a problem because they have other people in their social network to return to. People with friends and relatives can be provided the care and support one needs to face difficult life-altering circumstances. But what about those people who have lost the one friend they had? To whom do they turn? If there is no one left, or their relatives live far away, they return to emptiness (in terms of social network). For these people, getting “better” results in a significant decrease in social interactions (adult/staff attention). The better they are, the less contact they have with people.

It is important to address why a functional evaluation is just as essential as traditional diagnostic evaluations of persons in this circumstance. A traditional view begins with the assumption that verbalizing the statement “I feel I might kill myself ” is a symptom of depression or low self-esteem. Given that view, the professionals involved will “pull-out all stops” to make this person less depressed. They will probably provide antidepressant medications and increased professional services (including individual and group therapy). What this regimen establishes has both short- and long-term ramifications. First, after receiving such services, the person does feel better, that is, less depressed. That is the short- term result of such statements, which is essential. Additionally, such statements proved to be very effective in recruiting social interaction when desired. If social interaction and attention is less available for the client once released from the inpatient setting, the EO for attention develops over time. Hence, the longer the client goes without social interactions while in the community, the more likely such statements can occur. This process, in effect, establishes a cyclic pattern of improving and worsening. The functional utility of such statements in accessing attention, as well as the person’s loss of attention from professionals as he or she gets better, needs to be considered if we are to develop more effective interventions for people diagnosed with mental illness.

If mental health systems take such a possible function into account, would it replace the current system? Absolutely not! People who say they are going to commit suicide need attention! It is currently impossible to determine with great reliability and precision who is likely to follow through with this threat and when. However, what a functional analysis will add to the comprehensive treatment of these people is the concurrent development of a social network for them when they leave the facility. Perhaps developing conversational skills as well as social trips to local community centers while they are inpatients would be therapeutic. Making new friends and contacts would be a treatment objective. Professionals would spend as much time in developing these clients’ new circle of friends as they would in triaging the presenting complaint. In short, giving such a person many reasons to live is the best long- term approach, one facilitated by a functional analysis of the maintaining contingencies.

Will Steal for Social Attention. A 12-year-old female living in a foster home was referred to Keven Schock. The psychiatric staff were considering putting her on psychotropic medications due to her diagnosis of kleptomania. The referral was to determine if she could control herself in this matter or if it was purely neurological (hence the need for medication as the only effective solution). This young woman would steal daily, often items that were of no real value to her. Among the items reported to have been stolen were a broken pencil, other students’ school work, a kitchen egg timer, and even a pair of dentures! Now most people would assume that the reinforcer for stealing is the DA to the desired item (i.e., DA 1.2: Tangible Reinforcer).

In this case, that diagnosis did not fit. The items she stole were not items used by her. They served no purpose in her life. So why might someone steal items that were of no use to him or her? Keven asked one of the staff persons, “What does she do with these items?” The staff person’s reply was, “She leaves them on her desk in her room. I think she must be psychotic or something. She does not have any sense to hide them. She leaves them where she knows I will find them.”

Could it be that this person desires to get caught? But why would someone want to get caught? Is such a purpose best explained by invoking an existential crisis theory? When

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Keven asked staff what happened when she got caught, the reply was illuminating. “I punish her by giving her long lectures on how bad it is to steal, but it just isn’t working, I think she has low self-esteem and wants to be punished” (there you go, an existential crisis). Perhaps she is a masochist!

Can an analysis of behavioral function support another explanation (one rooted in some form of reality)? Perhaps she desires attention, in whatever form. Consider this hypothesis. If she had minimal ability to initiate interactions, she might be forced to rely on another behavior to interact with people. Her stealing did not seem to be a function of access to tangible reinforcers. It also did not occur under conditions that would promote escape or avoidance behavior. Rather, it was her most effective way to access adult attention.

SMA 2.2: Peer Attention. This diagnostic category encompasses problem behaviors that gain desired peer attention, particularly when peer approval is a powerful reinforcer, that is, presence of deprivation EO. This function exists more frequently in school settings with adolescents (e.g., class clown phenomenon) but can be operable with other clients where peer attention is a desired event.

In order for peer attention to function as a maintaining contingency for target problem behavior, peer attention has to be available. Given that children, adolescents, and adults can transmit information regarding the display of behavior, peers can either be physically present (e.g., in the classroom at the time of the behavior) or be able to be informed of the incident. But peer attention is not solely a function that is endemic with adolescents. It can also be a powerful motivating condition for adults as well. For example, some adults engage in behavior that recruits peer attention or approval as well (e.g., man or woman who “brags” about sexual conquests to buddies, or brags about other phenomena that recruit approval from peers). Other examples for adults can include the “necessity” to buy certain types of items such as cars, clothing, and so on to achieve or maintain some form of social status (i.e., peer attention).

Behaviors that reliably access peer attention become strengthened, particularly in social environments where peer approval is a powerful reinforcer. Problem behavior maintained by peer attention might be hard to detect because the approval or attention of peers may not occur immediately. In fact, with older children, some problem behaviors are reinforced by peers at a later time when they find out about the misbehavior (e.g., aggressive or disruptive behavior).

This function involves a reliable relation between the problem behavior and the access to desired peer attention. Other more acceptable behaviors are less likely to result in peer attention. Although the target problem behaviors may occur sometime before certain peers become aware of the incident or behavior, the delayed result still maintains the behavior. Teacher or adult attention may occur much closer to the problem behavior but may not be a factor in its maintenance (deprivation EO for adult attention not operable). Very often, an incorrect hypothesis about such behaviors in this subcategory being maintained by adult attention leads to an ineffective strategy. The following examples illustrate this point.

Everyone Loves a Clown (Except the Teacher). An example of problem behavior maintained by peer attention is a hypothetical junior high school special education student, Billy. He is referred for a functional behavioral assessment for his verbally inappropriate behavior toward teachers. Following is a sample of what transpires during an incident of inappropriate verbal behavior during a prealgebra class.

Teacher: Who can tell me what a linear equation is? Billy: (somewhat covertly, although within earshot of other students) What a bore. Teacher: Billy, do you have something to contribute to this discussion? Billy: I said what a core concept! (other students start giggling) Teacher: Perhaps you would like to teach this core concept. Billy: What for! (class breaks out laughing, Billy is sent to the principal’s office)

It is not difficult to surmise that such behavior is resulting in peer attention. When Billy makes such comments to the teacher, he gets the attention and approval of his fellow

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classmates. For a trip to the principal’s office, he now becomes the most popular kid in the class. He has peers wanting to hang out with him during recess and at lunch. Such peer attention and approval can often override the power of designated discipline strategies such as dismissal from class. It is important to diagnose these problems as SMA 2.2: Peer Attention in order to provide effective intervention.

It is important to note that while some people may view the teacher’s attention as the maintaining variable, such is not the case. Without peer attention that followed teacher attention, the level of the problem behavior would be much weaker. This is not to say that the teacher’s response to Billy’s initial smart remark did not provide the perfect forum for this student. It set the stage for peer attention to become more pronounced.

Suppose the teacher attended to other behaviors of this student that do not result in peer attention, such as raising his hand to be recognized. Would such have an effect on inappropriate verbal behavior? Many people, naive to an understanding of behavioral function, would vehemently respond with “Yes.” From what you know now, why would a change in this student’s behavior probably not happen?

Class Clown: It’s Elementary. A hypothetical second-grade girl engages in a number of inappropriate behaviors, such as sticking her tongue out at the teacher (when the teacher is not looking), dropping her pencil, and making faces. Despite the fact that the teacher admonishes her for engaging in such behaviors, the peer reinforcement for such behaviors is far stronger than the admonishment she receives. She becomes the most popular student on the playground during recess. Subsequently, the rate of these behaviors is maintained at a high level as a result of their ability to get peers to attend and laugh with her.

SMA 2.3: Tangible Reinforcer Hypothesis. We have all seen children at the supermarket whine, cry, and throw a tantrum. Are they possessed by demons? Many people will comment that they probably want something from their parents. Very often, they are right. They have assessed the motivational condition correctly. What is also true is that this set of behaviors has been successful in the past in obtaining such desired items or activities. As a result of the adult’s mediation of such undesirable behaviors, they become more probable, and more appropriate behaviors that are ineffective at getting the desired item become less likely. In contrast to the DA category, DA 1.2, the client’s target behavior does not directly produce the item. The undesirable behaviors (at some level or duration) are mediated by a parent providing the item contingent upon the behavior. The delivery of this reinforcer makes such target problem behavior much more likely when the EO for a given item in future shopping trips at the store becomes strengthened.

Therefore, target problem behaviors that function to access a desired tangible item, object, event, or activity under a deprivation (EO) are strengthened (see Table 3.7). Further, other behaviors (perhaps more desirable) in the child’s or client’s repertoire that are ineffective or inefficient at producing such events become weakened.

In many cases, target behaviors functioning in this subcategory are usually misdiagnosed for problems maintained solely by adult attention (SMA 2.1). This can easily happen if one simply watches the first socially mediated event following the target behavior. For example, let us say that a student in a special day class for mild disabilities refuses to line up for adaptive physical education (PE). As a result, the teacher quickly moves until in close proximity to the student and may say something. If one assesses that the first social event that occurred subsequent to the behavior is the maintaining variable or function, one would classify this problem as an SMA 2.1, given a reliable relation between these events. However,

TABLE 3.7 n TANGIBLE REINFORCER FUNCTION

EO B Contingency (AO)

Absence of item or activity for a sufficient period of time AO, abolishing operation; EO, establishing operation.

Behavior occurs (at some frequency and/or duration)

Item or activity delivered in some form by someone

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after some protracted discussion, the teacher bribes the student to get in line by allowing her to carry her favorite doll while she goes to PE. Now you know the whole story!

The problem in accurately diagnosing behavior problems in this category is that the delivery of the desired event or item will also coincide with adult attention. This is always true because access to the item is socially mediated. However, one should recognize that adult attention is an incidental variable and that access to the item, activity, or event is the “driving force” for the behavior. This can be tested in an in-vivo hypothesis test comparing two conditions. In half the sessions, present only attention and praise for this student when the child gets in line. In the other sessions, provide the desired item if the child gets in line within a certain time. If the item is the power behind the maintaining contingency, guess what condition will result in the child getting in line more frequently?

The problem behavior may have to occur over some period of time before the adult provides the event or activity. In the case of children, the care provider or parent may initially attempt to ignore such behavior and not “feed into it.” The parent refuses to give the child what he or she wants. Such initial attempts at ignoring the behavior do not result in the problem behavior ceasing. Rather, the problem behavior escalates in form and duration. As a result of the child’s behavior worsening, the adult, under pressure (and wanting to now stop the behavior at all costs), gives the child the object or activity. It is essential to detect such a shaping of different exacerbated forms of problem behavior and durations by the parent’s response to both the initial form as well as the more severe form.

Sometimes the presentation of the tangible reinforcer is done in a manner that looks like the teacher, parent, or care provider is reinforcing appropriate behavior (e.g., “If you’re quiet for 5 seconds, then I’ll let you go outside and play.”). The child engages in appropriate behavior and subsequently is given the desired item. However, one should realize that the entire chain of problem behaviors has led to the client’s access to the item. It is not simply a matter of what behavior occurred prior to the delivery of the item! Table 3.8 presents questions to pose when considering this diagnostic subcategory.

This function involves a reliable relation between the problem behavior and the access to the desired item or event (Question 1). Other more acceptable behaviors are less likely to result in the desired item or activity (Question 2). Although the target problem behaviors may have to occur at some frequency or duration, they are more successful at getting the desired item or event than other more acceptable behaviors (Question 2). To reiterate, attention and other events may occur in the interim between behavior onset and delivery of socially mediated tangible reinforcement. Do not assume the events that are temporally closer to reinforcement are maintaining the behavior! Rather, in some cases, it is the ultimate delivery of the tangible reinforcer that is the driving force behind the client’s behavior. Let us examine possible examples of problem behavior serving this diagnostic category.

Elopement. A female client was frequently running naked down the driveway of a residential facility. Staff reported that this occurred at least twice a week. Several staff would follow her and try to talk her into coming back. Obviously being naked will result in adult attention, both from staff and passersby. But such attention alone did not seem to explain this periodic nude display in the neighborhood. The staff indicated that this client was perfectly capable of accessing attention from staff, multiple times during a given day. Further, on a

TABLE 3.8 n QUESTIONS TO CONSIDER FOR AN SMA 2.3 DIAGNOSIS

1. Is there a reliable, somewhat frequent relation between the problem behavior and SMA to the tangible item or event? What is the form of the behavior?

2. Are the target behaviors more likely to produce access to the item or event than appropriate behaviors?

3. Does the behavior occur under a sufficient state of deprivation, that is, relatively protracted absence of item, event, or activity?

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streaking day, her access to attention would be comparable to other days, suggesting that such was not in a deprived condition at the time of the behavior.

Keven Schock was tasked with determining what happens that makes her engage in such a behavior. She obviously returned to the facility at some point in time. Perhaps how the staff “bribe” her back might provide a clue. Keven asked how they got her to return to the inside of the facility (and put clothes on). Their reply was that they had to offer her a soda if she returned.

Can the access to soda be so powerful that it makes this client shed her clothes and run down the driveway naked? It must be that access to sodas via other means (i.e., behaviors) is pretty difficult. Apparently, simply running out of the facility with clothes on did not set the conditions for getting a soda. The following is a facsimile of an interview with staff to get at this information.

Keven: What else does she do to get a soda? Staff: Oh, she is not allowed to have sodas. She is on a restricted diet. She asks for

sodas all the time and we tell her that she cannot have one, as it is not on her diet plan.

Keven: What does she do when she gets a soda? Staff: Oh she guzzles it down, belches, and smiles.

Can you see that access to a soda, under the rigorous diet plan, becomes a deprived event? Further, acceptable behavior such as requesting a soda is not functional. Hence, the streaking behavior becomes functional under the motivational condition where getting a soda is highly sought by this client. Solving this problem now becomes easy. A quick conversation with the dietitian resulted in her being able to have one soda per day. The results of such a strategy confirmed my hypothesis. Once she had one soda each day, she did not streak down the driveway.

Milton, the Pincher. The stated relationship between Milton pinching people and getting a walk would make pinching more probable when he wants a walk. Hence, pinching behavior would be diagnosed with an SMA 2.3 category: Tangible Reinforcer. We would contend that pinching other people is a functional behavior when Milton desires a walk. Also, unfortunately other more appropriate behaviors are not more functional in Milton getting a walk.

DISCUSSION QUESTION 3C In Milton’s case, how would you determine that the walk is the maintaining contingency and not simply attention? How would you conduct an in-situ treatment hypothesis strategy for attention-maintained behavior to separate these two variables that occur together (i.e., in order to get a walk Milton has to have the staff attend to him)?

I Don’t Like What I Am Wearing! Some students with severe disabilities may soil their clothes, even though they are capable of independent toileting, to get a change of clothes (i.e.,  change to preferred clothes). Other students learn to rip or tear their clothes for the same purpose (i.e., they will be given more preferred clothing articles to wear once their old clothes are torn). As long as the student gets new clothes contingent on these behaviors, ripping or soiling clothes will continue to occur under conditions where the student desires a change of clothing. Although the teaching staff ’s behavior is understandable, it certainly presents you with a plausible function for this behavior. If you diagnose the deprivation EO to be one of wanting to obtain more preferred clothes, the suitable classification is SMA 2.3; Tangible Reinforcers.

I Am Hungry Now. A hypothetical female adult with profound mental retardation exhibits a frequent and sometimes intense form of aggressive behavior toward staff, particularly before lunch. She will hit and attempt to bite them. An examination of the function of such behavior may reveal that such behavior may be maintained by staff providing specific edible

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items to the client upon such behavior (once she is calmed down). They may even state, “If you calm down, I will give you a cracker or candy bar.” Although some staff may not realize that such a contingency is strengthening aggressive behavior, it is the entire chain of behaviors that is reinforced, not simply “calm behavior.” In order to get to a condition where a candy bar becomes available, aggression must occur first. If aggression does not occur, one cannot proceed with “calming down” after the fact! If this person is calm without engaging in aggression, it is highly likely that no candy bar will be rendered.

To complicate matters, such aggressive behavior may not eventually result in the desired item every time it occurs. The staff may report to you that they do not give her candy or crackers when she is aggressive (forgetting the times when it is used to calm her down). Of course, you realize that delivery of candy and crackers does not have to occur with every incident. Rather, some intermittent delivery of food can maintain such behavior, especially if other behaviors are even more unsuccessful than her aggressive behavior. When she wants the candy item, her best bet is to bite someone!

He Likes to Be Restrained. This real-life case illustrates how a chain of events that begins with a client being restrained for aggressive behavior can end in a tangible reinforcer. Often with clients who frequently engage in behaviors that terminate in restraint, personnel will claim they “like” being restrained. But an analysis of the events that transpire antecedent and subsequent to the restraint may be an eye-opening revelation as to true function.

In the mid-1980s, I was hired as a consultant for a training program for people with developmental disabilities. This program was set up for some clients just coming out of the state institution in a wave of depopulation taking place during that time period in California. These clients had some of the most disruptive and challenging behaviors of the persons leaving the state institution. This agency wanted to serve such persons (given a higher rate of reimbursement for handling such difficult behavior problems). It was not uncommon in this program for a client to have to be physically restrained as a result of potentially dangerous behavior. The restraint would occur at a point where the client’s behavior had escalated so that danger was imminent. The staff were well-trained in this procedure and executed it in a safe and efficient manner when needed. Over time, some clients needed to be restrained only every once in a while. In contrast, other clients were involved in a prone containment just about every day.

One client in particular was brought to my attention. His rate of episodes where he had to be restrained was quite high. The facilities behavioral specialist reasoned that restraint should always function as a punisher, because no one in their right mind could actually like that being done to them. Therefore, the specialist’s explanation of his behavioral episodes, involving aggression and property destruction, was that he was just “going off.” Unfortunately, when he got to this level of aggression and property destruction, there was no alternative except to restrain him. I thought, “Could there be an alternate compelling function, with a different, more powerful EO involved? What could he possibly be getting out of the restraint process so that accessing this tangible item or event would override the aversive aspect of the restraint?” The answer? Coffee!

Here was a typical scenario. As reported by staff, he would be restrained when his state of aggressive behavior reached the danger point. Prior to the restraint, directives to engage in more appropriate behavior were fruitless. It was as if he wanted to be restrained. Two or more staff persons would put him in a prone containment in a safe manner, preferably on a soft surface. As he calmed down, they began a process of releasing him progressively, until he was standing erect again. They would then have him sit in a chair. As a method to calm him down further, he was given lots of attention from staff, soothing comments, and coffee. The proof that coffee was the “smoking gun” was the following piece of information I obtained after viewing this phenomenon with my own eyes. Prior to the incident, if he asked for coffee, he was told he could not have any until lunch because he just had some for breakfast. Now do you see the competing differential consequences? Act up, get restrained; 15 to 20 minutes later, get coffee. Don’t act up, but ask nicely, no coffee.

Potato Chips: Bet You Can’t Have Just One. A hypothetical female client with schizophrenia in a day treatment program engages in property destruction. How does such a behavior relate to getting potato chips? The road to extra potato chips is long and winding, but the payoff is at the end. During snack time, after this client has finished her food, she will

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sometimes attempt to get up and get more snack items, particularly when the snack item is potato chips. This attempt is rebuffed by staff (i.e., DA behavior is ineffective). They get in front of her and direct her verbally, and sometimes physically, back to her chair. She may then scream and holler, in which case staff move her away from the dining table. She then knocks items off the adjacent table or any other surface that is in need of redecorating. As a consequence for such behavior, she is placed in time-out. Looks like none of these behaviors result in extra potato chips, right? Suppose that after the time-out, sometimes staff give her a half a bag if she was quiet during her time-out (as an incentive not to create havoc while in time-out). Now you see the whole chain of events and how such a behavior as property destruction can serve a food-accessing function. One has to get to time-out in order to have the possibility of payoff. Whatever behaviors result in staff giving her a time-out will become more probable when there is a sufficient state of deprivation for potato chips to produce an EO.

I Like Massages! Keven Schock was working in a brain injury treatment center and was asked to assist with the case of a preteen girl who was being physically restrained daily. In interviews with the staff, they reported that she would typically come home from the on- grounds school, enter the residence, and begin to engage in a series of escalating behaviors. She would verbally taunt the staff and other residents. The escalation of severity of this problem behavior eventually involved self-injury or attacking other residents and staff. At that point, the staff felt they had no other option than to physically restrain her to stop her from injuring herself or others. In Keven’s review with staff of the restraint events, there were no clear antecedent events that were reliable and consistently correlated with the escalating chains of behavior. Likewise, there were no consistent consequent events other than the physical restraint. The function of such dangerous behaviors was unclear to Keven at this point.

Keven started treatment with staff implementing noncontingent reinforcement (NCR) for social attention and tangible items/activities. While the staff were walking home with her, they provided continuous attention; when she got home, the attention continued; she had free access to tangible items and activities. Keven also implemented noncontingent escape (NCE) for all demands in the home; hence staff made no demands for her to complete any tasks once she reached the residence. In other words, Keven removed most of the deprivation and aversive EOs that could possibly be involved. Unfortunately, the treatment outcome was not as comprehensive as hoped for. The effect of this treatment intervention was to prolong by about an hour the need for a physical restraint for dangerous behavior.

In reviewing the restraint events, the staff noted that she would struggle against the physical hold for 5 to 10 minutes; thereafter she relaxed, seemed calm and actually appeared to be happy. After the restraint event she would be cooperative and not have any major problems until the following day when returning home from school. Then the same routine began again with the sequence ending in restraint. Did she “like” restraint, or perhaps some aspect of the physical contact that occurred with the restraint? Keven decided to test the hypothesis that the physical contact was the maintaining event. On the way home from school there was a physical therapy gym. Keven convinced the agency physical therapist to provide her a deep tissue massage prior to her returning home. Keven and the staff were pretty sure we were on the right track during her first massage when she was smiling broadly during the massage. The hypothesis was confirmed when she returned to her home and did not engage in the series of behaviors that resulted in restraint. There were no more restraint events on days she received deep tissue massage.

Category: DE 3.0 The behavioral function of this major category involves particular behaviors that directly terminate (or completely avoid) an aversive event. For example, you feel an itch on your leg, which produces a certain level of discomfort. This antecedent context sets up the motivational condition for some behavior to relieve the aversive state—the itch. You scratch that area in a certain manner that causes the minor discomfort to disappear for a while (termination of aversive event). Scratching the itch brought about its removal directly.

DE functions can often be operable when clients are involved in situations or activities involving task demands. A client or student is presented with a nonpreferred task or demand.

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This aversive event thereby creates a sufficient state of aversion (i.e., aversive EO) which establishes the value of its removal. Leaving the task area directly produces at least a temporary cessation of the demand or task. What staff do after the behavior will determine whether such behavior will result in temporary postponement of the work task or permanent removal. If staff begin to prevent the client from walking away from the area, another “escape” behavior may take its place. The client may learn that in order to be successful in getting away, one cannot simply walk away because staff will prevent the client from leaving. Perhaps running from the area and down the hall may prove to be more successful in escaping the task. Hence, the client has now turned into a “runner” in order to make it more difficult to be impeded in escape from the task.

Other contexts that may generate DE behaviors are aversive social or physical environments. Many people find noisy areas an intrusion, and given sufficient exposure to such, seek to leave the area by walking away. Leaving the noisy area for a quiet area is sometimes an option for many of us. However, clients or students leaving a noisy area without requesting permission from staff or teachers can constitute a problem in facilities and educational institutions. Such unauthorized leaving will result in staff or teachers preventing such a behavior, thus rendering it ineffective. But for this particular individual, the aversive nature of the noisy area still prevails. Hence the aversive EO will still set up the motivational condition for a function. What behavior takes its place is up to the staff and/or teachers. If an alternate acceptable behavior is delineated as the mechanism to produce escape, then a management problem is averted. Unfortunately, when no decision to select such an alternate behavior is made, other equally undesirable behaviors take its place and may prove harder to obstruct.

Crowded or odorous environments can constitute aversive situations for many people. Problem behaviors such as leaving or running away from the scene can be effective in producing the direct termination of the aversive event. But such behaviors can cause a significant management problem for staff who work with clients who should be directly supervised at all times.

DON’T JUST GET UP, HIT SOMEBODY!

A hypothetical male student with severe disabilities gets out of his seat during group instruction time and sits next to the computer. He is immediately brought back by staff. Further, to prevent such an episode from recurring, the teacher places an aide right next to this student so that the aide can stop the escape from the group activity early in its genesis. Over a brief period of time, this student learns the futility of just getting up and walking out. Hence, such DE behavior becomes less likely.

However, the aversive condition has not been diminished. He is still faced with the task. His motivation to engage in some behavior that results in escape from this task is still relevant. He then hits another student during this group instruction time. The teacher immediately directs the aide to guide him to the time-out area to teach him “We do not hit in this class!” With such a contin- gency, the rate of this student’s hitting peers during group time increases to a daily occurrence. Is this teaching him a lesson? Yes, it is! When you want out, hit someone.

DISCUSSION QUESTION 3D What reinforcement operation explains why the teacher in this hypothetical scenario may continue to use time-out despite its function? Hint: Thank about what happens when this student is put in time-out and about the length of time he spends in that area away from other students.

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The subcategories under DE functions (in addition to the other category) are DE 3.1: Unpleasant Social Situations; DE 3.2: Lengthy Tasks/Chores/Assignments; DE 3.3: Difficult Tasks/Chores/Assignments; and DE 3.4: Aversive Physical Stimuli/Event.

DE 3.1: Unpleasant Social Situations. This diagnostic category encompasses problem behaviors that directly terminate the client or child’s engagement or interaction in unpleasant social situations (an aversive EO for that particular individual). Here is an illustration of the DE function. A client is at a work station with a number of other clients. One of the other clients engages in screaming and other tantrum-type behavior. This client runs to the corner of the room, and then eventually goes out the door, leaving the area. The motivating condition for this set of behaviors was an aversive social situation, that is, the other client screaming. This  client terminates the aversive condition directly by leaving the area. Perhaps such a behavior had been learned over many years of similar circumstances where screaming clients often follow up such bouts with another disruptive behavior, that is, they start hitting other people.

DE behaviors that can occur under unpleasant social situations can include leaving the facility, home, or classroom without permission; running away; or moving to another area. Many DE behaviors often involve the client’s response to the administration of a discipline procedure. For example, a child does something wrong during outside recess and is taken to the fence area as a time-out procedure. While unsupervised, the child leaves. Leaving the area would not be considered a behavior that is maintained because of adult attention! Rather, its ability to directly terminate the time-out (aversive EO) is what makes it functional and more probable in the future. Perhaps the child’s presence in the area should be more closely supervised.

The following circumstances can constitute aversive social situations (Cipani & Cipani, 2017):

simple compliance with adult requests, criticism (with respect to behavior, work performance, or criticism of appearance by peers), adult disapproval statements, social interactions (with a certain peer or adult, having an argument, having a large number of people in a room, having just a few people in a room, lengthy conversations) and threatened or implemented intended punishment consequences for behavior (removal to time-out, removal of privileges, fines involving points, etc.).

Table 3.9 illustrates that the establishing operation for this subcategory of problem behaviors is the presence of an aversive or unpleasant situation (first column). One must take into account that aversive is a relative term for that individual client, at that point in time. What is aversive or unpleasant to one person may not be to another. Further, the same situation may be less aversive to an individual on Monday than it was for the same individual last Sunday.

Such an antecedent context sets up the motivational condition for behaviors that escape (or avoid) such aversive events. The behavior becomes functional in that circumstance when it is successful at directly escaping or avoiding that situation. Note that in categories where the escape of the aversive situation occurs directly as a function of the behavior, the social consequences that follow such behavior are tangential and inconsequential. Table  3.10 presents some questions that are relevant for discerning such a diagnosis of DE 3.1: Unpleasant Social Situations.

TABLE 3.9 n ANALYSIS OF DIRECT FUNCTION EFFECTS FOR AVERSIVE SOCIAL SITUATIONS

Establishing Operation (EO)

Behavior Contingency Future Probability of Behavior Under EO

Presence of aversive social situation

Engages in problem behavior

Aversive event terminated immediately, removes aversive state

More likely when aversive event is present in the future

EO, establishing operation.

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Running Away From the Facility. A hypothetical client living in a group home facility for female adults with mental disorders and disabilities wants to go to the mall on Saturday. In this facility, clients must earn outside community privileges on the weekend through a point system. If a client earns a certain level of points by Friday, by behaving appropriately, following staff directions, and completing designated chores, she can earn a trip to the mall with the rest of the clients on Saturday afternoon. Further, other weekend community activities are also available to the clients who earn the prerequisite number of points. However, if a client does not earn the required points for that week, that client has to stay back while the remaining clients go on their community outing. To make such a consequence even more unpleasant, the client staying in the facility has to do extra, nonpreferred chores during this time.

When this client does not earn enough points, she leaves the facility on Friday night or early Saturday morning. In the past 4 months, she has left the facility unauthorized five times. Four of these five occasions were on weekends where she would not have earned community privileges. What is the reason for this potentially dangerous behavior? If she does not earn the points needed, she resorts to leaving on her own and avoiding chores and staying back. The primary consequence of leaving is simply to be brought back to the facility when found. Can you see how such a behavior will continue to occur under these conditions (i.e., not earning enough points)? As she becomes more skilled at navigating life outside the facility on her own, other contingencies become operable. In addition to escaping an aversive condition, she also enjoys some activities that are available only outside the facility. Such powerful results make leaving the facility more likely each weekend, whether she earns enough points or not.

DE 3.2: Lengthy Tasks/Chores/Assignments. This diagnostic category encompasses behaviors that postpone or terminate the child’s or client’s engagement with an instructional task, chore, or demand. The Cipani BCS contains two DE categories relating to instructional tasks or chores creating an aversive EO. Determining that an escape function can exist for such tasks does not reveal the actual aversive element or feature. The question must be raised: Why does such a task create an aversive condition? To address such a query, this manual examines two possibilities: (a) relative duration or length of task and (b) relative difficulty of task. The former element is inherent in this category, while the latter category is addressed in the next function: DE 3.3.

In this category, the value of escape is established because the task or chore is lengthy in duration. Lengthy is a relative term. What may be lengthy to you may be of short duration to me. Such a context sets up the motivational condition for behaviors that escape (or avoid) such conditions. The behavior becomes functional in that circumstance when it is successful at DE or avoidance of that instructional condition. The social consequences of such behavior are inconsequential. In many cases, such social responses following the behavior are often misdiagnosed as the primary function of the behavior. If escape is produced directly, what the teacher does or says after this result is not the “driving force” behind the behavior. Table 3.11 presents questions to pose when considering this diagnostic subcategory.

TABLE 3.10 n QUESTIONS TO CONSIDER FOR A DE 3.1 DIAGNOSIS

1. Is there a reliable, somewhat frequent, direct relation between the problem behavior and termination of the undesired social situation? What is the form of the escape behavior that directly terminates the aversive event?

2. Are the target behaviors more likely to produce escape from the situation than other more appropriate behaviors to terminate a social interaction?

3. Does the behavior occur when the aversive social situation is presented (or about to be presented)?

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In this subcategory, the child (or client) is capable of performing the assignment or task, but the duration of the instructional activity required is above his current “comfort zone.” For example, a student can perform at adequate levels addition and subtraction problems involving carrying and borrowing. If given only five of these to do, no problem behaviors emerge. He or she finishes these and then proceeds to something else (hopefully more preferred). However, when given 50 to do, the student gets out of the seat, digs into his or her backpack looking for something, and performs other such avoidance behaviors. “Daydreaming” during seat work time is an example of a behavior that directly produces disengagement with the instructional material.

The professional attempts to analyze the antecedent conditions inherent in such target behaviors and also looks for contexts where assignment completion occurs. Examining how effective such possible DE behaviors are in the presence of lengthy tasks allows for a more accurate prescription to this problem. Manipulating the difficulty of the task is not the answer. Some form of altering task length is one component of a functional behavior analytic strategy.

Many teachers would report they reinforce appropriate behavior. However, the controlling effects of lengthy instructional periods may make termination of instruction a contingency that is more powerful than the use of praise and teacher attention as contingent events for

TABLE 3.11 n QUESTIONS TO CONSIDER FOR A DE 3.2 DIAGNOSIS

1. Is there a reliable, somewhat frequent, direct relation between the problem behavior and termination of the client’s involvement in the task or chore? What is the form of the escape behavior?

2. Are the target behaviors more likely to produce escape from the instructional tasks or chore than other more appropriate behaviors?

3. Does a “wacky contingency” exist (thus setting up an aversive EO)?

THE CASE OF “WACKY CONTINGENCIES” IN THE CLASSROOM

One might assume that appropriate behavior (e.g., staying on task, doing one’s work) is routinely reinforced in the classroom. When asked, most teachers would reply, “Of course I reinforce good behavior.” But what do they mean when they say, “reinforce good behavior”? Let us look at a typical series of events in the classroom and examine whether reinforcement is delivered for appropriate behavior, such as assignment completion.

At 9 a.m., the teacher hands out the math assignment to all the children in the classroom. The math period on the daily lesson schedule is slated for 9:00 to 10:00 a.m. At 10:00, the students are slated for a 10-minute recess period before the advent of another instructional period. Let us examine closely what happens to two different students, Jacque and Jeanette, in this hypothetical math class during a day in September. Both students are given similar assignments and have similar abilities. Both students also would rate math work as a less preferred task to other more interesting activities.

At 9:00 a.m., the teacher hands out the math assignment sheets, which consist of 25 calculation problems, and requests that the students begin working on their assignments. Jacque, disliking the assignment, says to himself, “I’m not sure I like this but I’ll work hard and get it done. Then I’ll get something else to do.” Jacque proceeds to work hard on the math assignment. Jeanette has similar thoughts, except she tells herself, “I’m not ready to do this yet so I think I will go sharpen my pencil and get my papers organized and get ready for the next period, which is more to my liking.” Subsequently, Jeanette does a minimal amount

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of work on the assignment, looking for every opportunity to do something other than the math problems.

Shortly after the period has started, Jacque has completed his work and goes up to the teacher and turns in his paper. The teacher remarks, “Jacque, what a wonderful job you’ve done. This is an exceptional paper. I’m so proud of you, and I know your parents would be proud of you also. Now let’s see how you do on this one (as she gives him another sheet).” (In the teacher’s mind, she is telling herself—“that’s the way to reinforce him for his work; I really gave him lots of praise. He’ll probably want to do a really great job on that new math sheet.”) Meanwhile, the teacher notes that Jeanette has not even finished the fourth problem on the assignment. She scolds Jeanette, and tells her that if she doesn’t finish her math assignment that she’ll have to do the same sheet over again tomorrow (the teacher notes to herself— “I’ll not praise Jeanette for her performance.”).

One may be tempted to laugh or discount this as an unusual situation, but it is all too frequently the case across many classrooms. Why is this a wacky contingency? The teacher certainly praised Jacque for completing his assignment! Can one say that reinforcement occurred for appropriate behavior? To answer that question, one has to examine multiple consequent events for completing the assignment. When Jacque finished the assignment, he received praise and more work! Note that the completion of the assignment results in more work. Jacque does not receive any additional reinforcer or incentive for completing his work, but rather is given more work (a nonpreferred task). Also, note that Jeanette’s failure to complete the assignment merely resulted in the work being postponed until the next day’s math period. Both children get the same amount of recess. Therefore, recess is not a contingent event that is based on assignment completion. Rather, it is time based, that is, when it is time for recess, apparently everyone goes, irrespective of the amount of work done.

Under these conditions, what can we predict for the future? Jacque may learn that finishing work usually results in more work. One can imagine what will happen to his work production over time. He eventually begins to complete his assignment less frequently. Jeanette learns to put up with scolding and disparaging remarks but still gets recess like everyone else. She is described by her teacher as a student who doesn’t care  about reinforcement (because she obviously doesn’t do her work to receive the teacher’s praise).

What is the wacky contingency? Complete your work—get more! Fail to complete your work—get less! Fix that and you will be very successful in having many students become more adept at completing their assignments in school.

appropriate behavior. Lengthy instructional periods, both in general and special education, would seem to be a prevalent context for problem behaviors, as the following example illustrates.

I Need a Break. A hypothetical female student with severe disabilities is given a task, which she completes. On days when she is given small amounts of work, followed by a break, the staff report she is not a problem. However, on days when there is more work, staff report that she more often lays her head down on the table.3 Staff ascribe such behavior to the possibility that she did not get enough sleep the prior night. She lies there for 5 to10 minutes and then gets up. Some days, she lays her head down a little longer. School staff want to speak to her mom about her sleep habits. Unfortunately, the information relayed does not seem to support their contention. Rather, she is more likely to engage in that behavior when the instructional task lasts longer than 20 minutes. Would you say she has learned how much work she wants to do in one stretch?

Making Many Beds. Some adult clients have problem behaviors when required to complete a chore. One should not assume that the difficulty is with the procedural aspects

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of the chore. The client can perform the requisite steps of the chore; hence difficulty is not the feature creating an aversive event. It is the length of the chore. Let us say a hypothetical client was given a position at a hotel as a maid. This was perceived as a “good fit” because the residential staff reported that she was able to make her bed every morning.

Several weeks after her start, she was let go for not performing her duties. Although she was able to make a few beds, and made them up to standard, the problem was in the lack of completing all her assigned rooms. Realize that if you work for a hotel in supported employment, you must make many beds. This duration mismatch created an aversive condition for that client. She would hide from the supervisor or fall asleep on one of the beds. Taking her own extended breaks directly escaped the lengthy task, and also got her fired. To say that she engaged in avoidance behaviors because she wanted to get fired would be fallacious. She would be perfectly happy having to do only a few beds a day and still be employed. The easiest explanation is not always the correct one.

DE 3.3: Difficult Tasks/Chores/Assignments. This diagnostic category encompasses problem behaviors that directly terminate the task or chore, with such escape responding generated by the difficulty of the task or chore. The aversive state is created because the task or chore is relatively difficult. Difficult is a relative term. What may be difficult for you may be easy for me (and vice versa). Such a context sets up the motivational condition for behaviors that escape (or avoid) such aversive events. The behavior becomes functional when it is successful at directly escaping or avoiding difficult tasks or instructional demands. Note that the social consequences that follow such behavior are inconsequential in terms of strengthening the behavior (column C). Table 3.12 presents questions to pose when considering this diagnostic subcategory.

Much passive off-task behavior is DE from task engagement. Such off-task behavior does not constitute a problem until its duration exceeds expectations of the classroom. When the duration of “taking a break from work” exceeds expectations, teacher admonishment occurs. Therefore, if longer breaks from work are desired by the student, some problem behavior that removes the student more permanently from the classroom is needed. To reiterate an earlier point, students who are faced with difficult material will often engage in disruptive escape behaviors that are socially mediated. The more disruptive, the more likely the student will get removed from the instructional situation by an adult.

Instructional Mismatch. In school settings, instructional tasks become aversive EOs when students are not capable of performing certain academic tasks accurately or fluently. Children who are given academic tasks that are way above their current level face this on a daily basis. For example, giving a child a seat work task involving decimal problems may be appropriate for his or her grade level. However, if he or she is capable only of adding and subtracting single-digit numbers, an aversive context is generated. This content level mismatch creates the conditions for escape or avoidance as a powerful motivating condition. This is a sure prescription for developing an aversion to math time, that is, constantly exposing the child to material with which he or she has very little chance of succeeding. In these cases, the child may engage in behaviors that avoid attending to the instruction or

TABLE 3.12 n QUESTIONS TO CONSIDER FOR A DE 3.3 DIAGNOSIS

1. Is there a reliable, somewhat frequent, direct relation between the problem behavior and termination of the relatively difficult task? What is the form of the escape behavior?

2. Are the target behaviors more likely to produce escape than other more appropriate behaviors to terminate the client’s engagement in the difficult task? On what type of reinforcement schedule is it? Is the client thwarted in his/her attempts to directly terminate his/her engagement in the task? How long or often do such behaviors have to occur before they are successful?

3. Does the problem behavior occur in the presence of difficult tasks, chores or instructional assignments (i.e., aversive EO)?

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task, such as daydreaming, reading comic books, and so on. If these behaviors are frequently impeded by teaching staff, then other more disruptive behaviors evolve. With that evolution comes the referral for a behavior management program.

DE 3.4: Aversive Physical Stimuli. If you mistakenly put on clothes that are too tight, you would remove these clothes and put on other clothes. Such a chain of behaviors is functional in that it produces the termination of the aversive event directly. Suppose you are prevented from changing clothes because personnel see such a behavior as your wanting to “control your environment”? Would you resort to behaviors deemed maladaptive? If you are faced with this daily, you probably would. Except that such behaviors are not necessarily maladaptive, but rather functional if the result is a change in clothes (see Table 3.13).

What are some other examples of DE behaviors terminating an aversive event? Upon hearing a loud noise coming from your smoke alarm, you may generate a chain of behaviors that eventually results in disabling the connection between the battery and the smoke alarm (assuming there is no fire). It is the last step that is performed that produces the direct cessation of the noise, hence negative reinforcement. People often leave an area that smells, put a coat on when it is cold, take a break when one has been working too long, and so forth. Although such behaviors are certainly understandable, with some clients or students, the manner in which they escape the aversive physical situation is unacceptable.

The differentiation between this subcategory and the previous categories is the imposition of a discrete physical stimulus that the client finds aversive (i.e., not a social situation). The following are some examples of problem behaviors in this subcategory.

Nude Clients. Some clients in residential and educational programs periodically or frequently engage in ripping or tearing off their clothes. Although the suggestion that such behavior is maintained by social attention is pertinent, that does not always turn out to be a correct diagnosis. What might be an alternate maintaining contingency for some clients? If the clothes the client is currently wearing are less desired, or if the client is used to some other fabric (e.g., cotton, silk), the motivational condition exists for escape behavior. Ripping off one’s clothes produces a direct effect on clothes removal, for example, fabric touching skin is no longer existent. If staff have difficulty finding other clean clothes, all the better (from client’s perspective).

Although tearing off clothes can result in adult attention (whatever is said or done), one must not always assume that such attention is the maintaining variable. Although nudity will certainly result in attention, the primary function is DE from the nonpreferred clothes. If the client was allowed to change into new clothes, he or she probably would not run around the unit nude. An analogue test for this hypothesis would be to allow the client to change into new clothes when signaling the desire (may have to be taught) for several weeks. This will remove the aversive context of wearing nonpreferred clothes for this period of time. Then for the next

TABLE 3.13 n DIRECT ESCAPE FUNCTION: AVERSIVE PHYSICAL STIMULI

EO B Contingency (AO)

Presence of aversive stimuli Behavior occurs (at some frequency and/or duration)

Aversive stimuli removed

AO, abolishing operation; EO, establishing operation.

DISCUSSION QUESTION 3E Explain how instructional variables and problem behavior are inextricably intertwined. When students fail repeatedly with their class assignments, what condition does that set up?

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several weeks, institute a second condition: do not reinforce the request to change clothes. This will create the aversive EO again. If tearing off the clothes and nude appearance are low in the first condition while very frequent in the second condition, you have your answer.

Misdiagnosing this problem as an adult attention function (subcategory SMA 2.1) would lead to an ineffective treatment. Attending to this client when clothed and not attending when nude would do little or nothing to solve the problem. In fact, it may lead to longer durations of nudity because ignoring would elicit no response on the part of staff to get the client dressed!

In cases involving clients who rip off their clothes, why does an alternate, more acceptable behavior not occur, such as a request for different clothes, or changing clothes in a private area? Such behaviors may not be present in the repertoire of the client (see Chapter 4 on classification categories of replacement functions). It may also be the case that such behaviors are in the repertoire of the client but not reinforced by staff. Suppose a client is capable of taking clothes off appropriately in a private area, but staff block attempts to undress. Consequently, such an acceptable behavior is not functional. Similarly, requesting different clothes that are not as uncomfortable falls on deaf ears. Given these impediments to other behaviors, ripping off one’s clothes becomes an effective action to remove the aversive stimuli.

Head Bang From a Toothache? A young man with multiple disabilities was unable to speak and had a history of engaging in mild head-slapping behavior. The staff were instructed to simply interrupt him when he engaged in self-abuse and redirect him to his assigned task. They guessed that he was doing this to obtain attention because he kept doing it. Their next plan was for such behavior to be placed on extinction, that is, removal of staff attention.

Unfortunately, the intensity of the head slapping increased. If their hypothesis was correct, the removal of attention should have resulted in a decrease in this behavior. Concurrently, another behavior that would be more successful in getting attention would have increased. Such did not occur with this treatment regimen (wrong diagnosis!). The young man proceeded to bang his head to the point that his mouth was bleeding and the side of his face was swollen. Another hypothesis needed to be entertained. Upon being brought into the case, Keven Schock immediately sought medical attention. Upon examination of the mouth area, it was discovered that this young man had developed an abscessed tooth. It is very likely that this abscessed tooth was quite painful. The face slapping was hypothesized to have directly alleviated some of the pain caused by this abscess, at least temporarily. When dental treatment was rendered, two subsequent phenomena resulted. First, the treatment successfully reduced the abscess. Equally important, the self-abusive behavior ceased completely.

Category: SME 4.0 SME problem behaviors remove or postpone aversive events, similar to the DE functions. It contrasts with the DE functions in that the child or client’s behavior does not directly terminate the aversive event. Rather, the aversive event is removed through the behavior of another person, for example, parent, staff, care provider, teacher, or peer.

Within this category are the following subcategories—SME 4.1: Escape of Unpleasant Social Situations; SME 4.2: Escape of Relatively Long Tasks or Chores; SME 4.3 Difficult Tasks/Chores/Assignments; and SME 4.4: Aversive Physical Stimuli/Event. Note that the same events that served as aversive EOs for DE behaviors can also serve as the motivational conditions for SME. To reiterate, the difference is in the manner in which escape or avoidance is produced. A tantrum cannot directly remove a child from an unpleasant social situation (its only effect is on sound wave production in the area). Rather, it can serve as a communication to a parent to mediate the situation. Upon hearing the child throw a tantrum, the parent “interprets” such as a message that the child is unhappy in the current situation and thereby removes him or her. When the child appears more pleased at getting away from this situation, the parent “stores this information” away for the next tantrum.

SME 4.1: Escape of Unpleasant Social Situations. This diagnostic subcategory encompasses problem behaviors that terminate the child’s engagement or interaction in

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relatively unpleasant social situations (unpleasant relative to that child). The antecedent motivational conditions match the DE subcategory of the same circumstance, unpleasant social situations. These would not usually be instructional conditions unless the social circumstance itself (e.g., child sits next to someone who teases) makes the instructional setting aversive, not the instruction. The presence of the aversive social situation sets up the motivational condition for the client to engage in escape or avoidance behavior that is socially mediated. The form of such behaviors is determined by how successful and reliable such behaviors are at getting a person to terminate an already existing event or postpone the advent of an upcoming aversive event. Please refer to the DE 3.1: Unpleasant Social Situations section of this chapter for a delineation of circumstances that would be representative of this category. Table 3.14 presents the questions to ask when considering this diagnostic subcategory.

Hiding. A boy, about 5 years old, was referred to Keven Schock because he had been hiding in dangerous locations in his house (once he was found in the oven). What would be the circumstance that would generate such hiding behavior? Through interview and descriptive analysis, the antecedent for such behavior appeared to be his foster mother attempting to discipline him. When he had engaged in some unwanted behavior, his foster mother would call to him (from another room). She asked him to come to her so she could reprimand him.

As you can imagine, her tone of voice would be different than if she simply wanted to talk with him. Her tone of voice was the cue for this child. Upon hearing her command for him to come, he would find the nearest place to hide; this could be inside kitchen cabinets, under furniture, or in the garden shed. The process of searching for him was so tedious and aversive that it altered the mother’s response. By the time she found him, she was so relieved, she would sometimes hug him instead of reprimand him. His behavior of hiding was quite effective in escaping any further, more intense, reprimand from his mother.

Spinning. Keven received a referral of a middle-aged man in a locked psychiatric unit with a diagnosis of schizophrenia. He had an unusual way of getting the doctors and nurses to quit talking to him. When they approached and began to interact with him, he would simply stretch out his arms and begin to spin in circles. Anyone within arms’ distance would be struck. This behavior was quite successful in getting not only the doctors and nurses to avoid him, but also all of the other patients.

TABLE 3.14 n QUESTIONS TO CONSIDER FOR AN SME 4.1 DIAGNOSIS

1. Is there a reliable, somewhat frequent, relationship between the problem behavior and termination of the undesired social situation? What is the form of the escape behavior?

2. Are the target behaviors more likely to produce escape from the situation by an adult, staff person, teacher, or parent than other more appropriate behaviors to terminate a social interaction?

3. Does the behavior occur when the aversive social situation (EO) is presented (or about to be presented)?

DISCUSSION QUESTION 3F What FBA data would indicate that spinning behavior serves a DA 1.1: immediate sensory stimuli function? If a trigger analysis found that he spun around only 30% of the total times staff approached him, what would you set up as a test of a diagnosis of DA 1.1?

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Shut Up and Leave Me Alone! A male client diagnosed with paranoid schizophrenia had been living in a locked psychiatric facility for 15 years (Schock, Clay, & Cipani, 1998). He had a lengthy history of hitting other people, primarily in the context of their initiating and maintaining an interaction with him. To say that his regard for small talk was not very high is an understatement! The collection of baseline data was not pursued due to the dangerousness of the behavior. However, an analysis of the possible function of this client’s aggression from records and interview seemed to indicate that hitting the other person resulted in his being left alone. The termination of the social situation as a result of hitting someone was hypothesized as the maintaining variable. Instead of saying, “Please leave me alone!” he would hit the other resident, which then produced the desired result of being left alone.

Developing an alternate behavior (instead of aggression) that would hopefully have the same function was required before he arrived at his new residential facility. His continued persistence at ending conversations by hitting people would probably make his stay at the community-based facility a short one. Prior to his arrival, Keven Schock and his staff decided to develop and reinforce a new behavior that would terminate a conversation and not involve hitting. The staff taught him to use the phrase, “Shut up and leave me alone!” They considered a more acceptable phrase, for example, “I do not want to talk to you anymore,” or “Please leave me alone.” However, those forms of protest may not have had the desired effect in the current facility. Residential staff persons might consider such a verbal request as a possible sign of needing help and continue trying to pry the client for information. Subsequently, he would be “forced” to hit that person to be left alone. Hence, more acceptable protests would be unable to reliably terminate the interaction, making such protests less functional than aggression. The selected target statement seemed like there would be no misinterpretation of its intent on the audience. Data over a 6-month period bore this out. The target verbal statement occurred regularly, while aggression did not.

Back to Level 1. Aggressive behavior can be an SME behavior, particularly when it occurs as a chain of events under conditions where a punisher is administered by staff for a client’s previous target behavior. For example, let us say a young boy at a residential facility does something wrong (i.e., a proscribed target behavior) and is moved down one level on the point system. As a result of being told he has been moved back to Level 1, he profusely swears at the staff person and begins kicking things, slamming doors, and throwing books against the wall. (Note to reader: Do not take this as our tacit approval of level systems of reinforcement. They are not our preference in behavioral intervention.)

Why does he engage in such a tirade? Such behaviors do not appear to be functional. The staff do not grant him his wish to go back to his previous level despite his verbal tirade. Perhaps what transpires after the staff intervene provides the explanation. Suppose someone in higher authority, hearing the commotion, meets with the child to calm him down. In the process of engaging in conflict resolution tactics, this authority figure makes a deal with the child regarding his return back to Level 2. What effect does such a negotiation have on the future probability of these reactions by this child to loss of a level on the system? Can such a negotiation “strategy” be the maintaining contingency for this child’s behavior when he is punished by staff and loses Level 2 privileges? Would this child have been offered a special deal had these raucous behaviors not happened? I think he will be more likely to act out in future situations where the only manner of ameliorating the consequence of his behavior is to knock things around.

This scenario may be quite familiar to people who work in facilities and group homes. It is sanctified as a clinical procedure and goes by the name of crisis management. What looks like a good way of handling an explosive situation in the short run (because the child stops intense tantrum behavior) is not beneficial in the long run because, as a result, these children have more frequent crises requiring the clinical expert to come in and render the situation manageable. This is done by negotiating the degree or amount of the consequences to be levied. Of course, such negotiation ameliorates the escalation of the child’s disruptive behavior at the time, but what is never studied or considered is the long-term effect of these frequent negotiations. How effective do you think the originally designed consequences will be in decreasing the initial target behaviors over several weeks or months? It would depend

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on how superb a negotiator the child is. The child may end up getting something instead of losing something!

Avoidance Functions. Many problem behaviors that occur under noninstructional conditions can be a response to the administration of a discipline procedure. In this manner, the occurrence of the target behavior may be strengthened more for its avoidance capability than for its immediate escape function. For example, a child does something wrong during recess and is taken to a time-out area. The child yells at the teacher, “I’m not going!” As the teacher escorts him or her to time-out, the child attempts to fight with and resist the teacher, hitting and kicking the teacher, resulting in an exacerbation of consequences. The child is then sent home for assaulting a teacher on the playground. Why do such behaviors occur while the child is being escorted to time-out? Aggression in this context gets reinforced if the adult is less likely to implement time-out for fear of stirring up a situation like the last time- out. When aggression, or the threat of it, conditions the social environment in that fashion, it becomes an effective avoidance behavior under threat of discipline.

SME 4.2: Lengthy Tasks/Chores/Assignments. This diagnostic category encompasses behaviors that postpone or terminate the child’s or client’s engagement with an instruc- tional task, chore, or demand. The analysis in Table 3.15 depicts the relationship between the antecedent context, the behavior, and the contingency produced, which makes the escape behavior more probable under similar antecedent contexts. To reiterate from the prior dis- cussion in this chapter, it is necessary to determine the reason for an instructional task being aversive. To address such a query, this manual examines two possibilities with respect to SME: (a) relative duration or length of task and (b) relative difficulty of task. The former ele- ment is inherent in this category, while the latter category is addressed in the next function: SME 4.3.

The value of escape is established because the task or chore is lengthy in duration (first column). Lengthy is a relative term. What may be lengthy to you may be of short duration to me. Although some of us may not mind cutting a small front lawn that takes only 15 minutes, we may not be comfortable with a lawn that is 4 acres (that’s why riding lawn mowers have a certain market share). In this subcategory, the child is capable of performing the assignment or task, but the duration of the instructional activity required is too long. Under this motivational condition, the problem behavior occurs. As a result, staff remove, ameliorate, or eliminate the task presented. Again, as with all socially mediated behaviors, the direct result of behavior is inconsequential in terms of stimulus control. The maintenance of the behavior is not determined by such a contingency being reliably produced.

Another point needs to be made in diagnosing this subcategory. Many professionals naive to behavior analysis believe they can determine the purpose of the child’s behavior by asking the child (or client) “Why do you do that?” Any professional report that uses the client’s statement to such a question as the sole basis for a diagnosis of behavioral function should not be taken seriously. Although the history of psychotherapy is one of accepting client self- report at face value, such a methodology cannot be relied on in a science-based approach!

Here is an example of the lack of utility of such questioning. When these children are asked why they don’t complete their work or assignment or engage in inappropriate behaviors, they often respond with “I am bored.” Personnel then believe that through this self-revelation, the

TABLE 3.15 n RELATIVELY LENGTHY TASK

Establishing Operation (EO)

Behavior Maintaining Contingency

Future Probability of Behavior Under EO

Relatively lengthy task

Throws a tantrum by swearing, kicking property, etc.

Task is removed by some person

More likely under the same or similar establishing operation

EO, establishing operation

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causative agent of the problem behavior has been discovered. This contention is ill-conceived on several grounds.

First, behavior analysis requires that controlling variables be identified through reliable and valid measurement. The reliability and validity of the client’s self-report cannot be ascertained. Asking the client why he or she did something does not give us a “window” into the person’s motivation. One can certainly question the correspondence between what someone says and what someone does. The field of psychology, which relies on self-report as a valid measure of motivation, is often ineffectual in changing behavior, particularly when there is a weak correspondence between saying and doing. To understand motivation, one must study and analyze the observable, reliably measured events surrounding the behavior. Hence, an FBA will always require that someone’s motivation to behave in a certain fashion be understood from a scientific measurement of variables in the environment. Second, this explanation does not lead one to understand how off-task and disruptive behaviors are functional. In fact, if boredom was the causative agent behind the child’s performance, then the treatment should be providing more challenging work. I will take bets on how well that works in getting the child to perform better in class.

Examining how effective such possible escape behaviors are in the presence of lengthy tasks allows for a more accurate treatment prescription to this problem. In this subcategory, manipulating the difficulty of the task is not the answer. Some form of altering task length would be a primary component of a functional behavior analytic strategy. The “Case of the Wacky Contingency” presented earlier illustrates why such a context is existent in many school classrooms across the country.

This subcategory can also be diagnosed with tasks or chores outside of a classroom setting. Some clients have problem behaviors when required to complete a chore. It is not a difficult chore for this client; the client can perform the requisite steps of the chore. Rather, it is the length of the chore that establishes the value of escape. One may be able to wash several dishes in a sink at home. However, if you work for a restaurant, you must wash many dishes, pots, and pans. This duration mismatch thus creates an aversive condition for that client, which sets the stage for behaviors that temporarily or permanently escape from the task. It is to be distinguished from the next behavioral function in that the child’s ability to perform the task (accurately) is adequate, but the length of time is the factor making escape from instruction a powerful motivating operation. The questions in Table 3.16 should be posed when considering this diagnostic subcategory.

TABLE 3.16 n QUESTIONS TO CONSIDER FOR AN SME 4.2 DIAGNOSIS

1. Is there a reliable, somewhat frequent, relationship between the problem behavior and termination of the lengthy task(s), chore(s), or instruction? What is the form of the escape behavior?

2. Are the target behaviors more likely to produce escape from the situation by an adult staff person or parent than other more appropriate behaviors to terminate a social interaction? On what type of reinforcement schedule is it? How long or frequent do such escape behaviors sustain before the aversive task, chore, or instruction is terminated by someone?

3. Des the behavior occur when the task, chore, or assignment is relatively lengthy for the individual?

DISCUSSION QUESTION 3G How would you conduct an analogue assessment to determine whether the problem behavior occurs during instruction because of length of assignment? Instructional difficulty?

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Hitting the Table and Social Mediation. A hypothetical student with severe disabilities will hit the table during instruction on a regular basis. Your observations may reveal that such behavior, particularly the lengthier and more intense it is, results in the teacher removing the student to another area. Although the short-term result is one of stopping the behavioral episode (which encourages the teacher’s belief of being on the right path), the long-term effect of such action is disastrous! The teacher is unwittingly developing such disruptive behavior as functional when the student does not want to continue in the instructional session. You have observed that hitting the table becomes highly likely when the instructional session goes beyond 6 minutes. Especially in light of the fact that there is no definitive criteria for instructional session length, hitting the table with some force inevitably occurs at some point in the teacher’s lesson. Although some people ascribe such behavior to the child’s intellectual disability, you now know better. You realize that the social environment has a big part in maintaining and probably exacerbating self-injury as an SME behavior.

What would be an analogue or in-vivo test to determine if length of task is the controlling variable in this case? In alternating fashion, the teacher would present one of two conditions during the instructional period in which this behavior occurred. In the first condition, on alternating days, the student would receive a short assignment. In the second condition, the student would receive a lengthy assignment (other days). An analogue test would mimic the controlling variables by removing the task, contingent on the exhibition of the problem behavior. The task would be terminated for a short period of time (e.g., 1 minute). If the results demonstrate that problem behaviors are prevalent in the second condition, especially when compared with the first condition, you have identified the aversive EO.

“I’m Bored.” A young girl is referred for property destruction, tantrums, and oppositional behaviors in the class. Your interview with the teacher and observations in the class reveal that when the student is given a lengthy assignment, she initially whines and complains, stating “I’m bored.” However, another more challenging task of similar length is met with this same complaint. When she is redirected back to work, she engages in more severe objections (tantrums and oppositional behavior) and eventually gets mad enough that she throws objects at the floor and wall. This results in the teacher removing the child to the corner until she can behave properly and do her work! Note the effect of the child’s throwing-objects behavior: the child’s termination of her engagement in the assignment for some period of time. Although the student can work for 15 to 20 minutes without a problem, working for 1 hour is just too much. Hence, the child has learned how to get a 5-minute break. Throw something!

Going Gandhi. A young female teenager, in and out of home placement could do any task or chore you wanted her to do. However, her actual performance left something to be desired. The group home staff constantly reported that she did not finish her chores. They ascribed it to her oppositional and lazy attitude, claiming she had a personality disorder. Her opposition would not be in a form involving aggression or destructive behavior. She did not yell or scream. Keven Schock observed the staff in one interaction with her. They were attempting to get her to get up, clean her room, take her medications, and come eat breakfast. She got up and went to a chair in the living room, and then she refused to move, refused food, refused medications, and refused to talk to anyone. She simply sat there, in protest, quietly like Gandhi.

An analogue test was set up to determine what could be the possible reason for not completing chores that were easy for her to perform under direction. In one condition, Keven assisted her in a simple task of room cleaning. If he gave her one-step tasks, she completed the task. All she seemed to need was one-step commands and contingent verbal praise after completing each step. However, when given a multiple-step direction, she did not complete the task. This was true even when offered praise and tangible reinforcement. During these tests it appeared that she was simply unable to complete the task. However, the same task could be accomplished if it was broken down into its unit components and performed one step at a time. Lengthy tasks were a “no go” at this time. Breaking them up into small units, and doing one at a time, solved the problem.

Enough Is Enough. A young girl with severe disabilities is given a task, which she completes. She gets out of her seat, but at that time, an instructional aide tells her to go back to her seat so that she can work on another task. She reluctantly complies, finishes part of it, and then

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attempts to leave her seat again. As she leaves her seat, the aide admonishes her to finish. She hits herself at this point, and the aide comes over to her and tells her to stop. She hits herself again, right in front of the aide. The aide then moves her to another area of the room with a different activity. If you were this child, what would you do the next time you felt you did enough work on a particular task or activity and wanted to change activities?

I Need a Break, My Brain Is Swelling. A mainstreamed fourth-grade boy in a regular class is given a reading assignment in a social studies text. The teacher has reported to you that this child will frequently throw a tantrum during class assignments. The teacher has suggested that maybe he does not belong in this class because it is too difficult for him. Your observation reveals that he reads about three pages during a reading assignment. He also is able to answer the questions correctly. He then decides to take a break and gets out some toy cars he brought from home. The teacher sees him playing, admonishes him, and gives him another reading assignment. He argues with the teacher, with no success, and then throws his social studies book on the floor. The teacher sends him to the principal’s office for defiant and disruptive behavior. The teacher decries, “That will teach him not to play in my classroom.” The child goes to the principal’s office and sits in the seat outside of the office with one of his cars in his pocket. You probably could fill in the rest of the story!

The 20-Minute Child. A child hits the desk to temporarily terminate the presentation of an instructional task. This scenario illustrates that the hitting-the-desk incident terminates instruction by the teacher, removing the instructional demand and subsequently “dealing” with the problem behavior. Note that the aggressive behavior is negatively reinforced by the teacher in that another stimulus condition is presented in the place of the task, for some period of time. Yelling and screaming can also accompany aggressive behavior intended to remove aversive events, often occurring before or during the aggressive acts.

Aggressive behavior results in the teacher removing the child to the corner until the child can behave properly and do the work. Note the effect of the child’s throwing-objects behavior: removal of the (aversive) assignment for some period of time. Although the student can work for 15 to 20 minutes without a problem, working for 1 hour is just too much. Hence, the child has learned to get a 5-minute break (i.e., throw things).

SME of Independent Seat Work. Some children who are deemed to have minimal impulse control when using a more traditional diagnostic classification, are found to throw tantrums and kick objects, desks, and other children (who are close by) when it is time to do seat work. Or they verbally refuse to complete the assignment. Note that turning to the minimal impulse control explanation does not give the slightest hint about what to do behaviorally. Perhaps medication interventions are apparent with this explanation. However, a behavioral intervention for minimal impulse control does not exist!

A functional explanation is far more useful in offering a route for intervention. If these behaviors serve to throw the teacher off track by dealing with these behaviors instead of pressing on with instruction, such behaviors can be maintained by serving an SME function. Although some students may be fine when working under close supervision, they cannot function adequately when more independence is required. The treatment strategy would

ASSIGNMENT: DURATION OR DIFFICULTY? There are two escape functions dealing with instructional contexts in the Cipani BCS. This assignment will require you to make the relevant distinction between these two categories. Please address the following points in order:

• What is the EO for an escape function due to difficult material?

• How is that different from an escape function due to the “wacky contingency?”

• Why might it be important to discern the reason for escape behavior as either duration or difficulty with special needs students who exhibit challenging behaviors in mainstreamed or inclusive settings?

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attempt to do two things: (a) not allow such tantrum behaviors to postpone or ameliorate the seat work task requirements and (b) select another more appropriate behavior that replaces the tantrum behavior to terminate seat work and get close supervision. Perhaps after completing some independent seat work, the child can get his or her chair moved closer to the teacher’s area (hey, a contingency, what a good idea).

SME 4.3: Difficult Tasks, Chores, or Instruction. This diagnostic subcategory encompasses problem behaviors that terminate the task or chore, with such escape responding motivated by the difficulty of the task or chore. In the presence of difficult tasks, chores, or assignments, the target problem behavior occurs. It is maintained in its particular form by its ability to escape or avoid such relatively difficult tasks.

In school settings, the child’s engagement with the instructional task is aversive, primarily because the child is not capable of performing the task accurately or fluently. This lack of skill sets the stage for escape from or avoidance of those instructional situations and conditions. This function occurs frequently with children who are given academic tasks that are way above their current level. This is a sure prescription for developing an aversion to school work, that is, constantly expose the child to material with which the child has very little chance of succeeding. In these cases, the child may engage in the problem behaviors to avoid all school work because such work is often something at which he or she is unsuccessful.

The questions in Table 3.17 should be posed when considering this diagnostic subcategory. Self-Injury Often Escapes Instruction. Very often, problem behaviors, such as self-

abuse, can function to remove instructional tasks or materials because the teacher has to stop instruction to deal with the behavior. Imagine seeing a young girl hitting herself repeatedly when faced with a task demand. Contingent upon this flurry of hits, the teacher attempts to hold her hands, thereby preventing her from hitting her face. But one must note what stimulus change gets affected in addition to physical contact. Instruction stops! As a result of the ability of the child’s self-abuse to terminate an instructional demand, hitting her face becomes more probable in the future when she is presented with the same or similar tasks.4

What would be an analogue or in-vivo test to determine if difficulty of task is the controlling variable? In alternating fashion, the teacher would present one of two conditions. In half of the sessions, the student would receive easy material. Such easy tasks would be determined by previous student performance demonstrating mastery levels of performance. For example, if the student is currently reading at the third-grade level as identified by achievement tests, an easy assignment would be first- or possibly second-grade reading texts.

In the other half of the sessions, the student would receive a difficult task or assignment. This could probably be accomplished by assigning reading material from the everyday work she does (third-grade level). An analogue test would mimic the controlling variables. Therefore, in both conditions contingent on the exhibition of the problem behavior, the task would be terminated for a short period of time (e.g., 1 minute). An in-vivo test would involve the same two conditions, except the break would be contingent on completing the

TABLE 3.17 n QUESTIONS TO CONSIDER FOR AN SME 4.3 DIAGNOSIS

1. Is there a reliable, somewhat frequent, relationship between the problem behavior and termination of the difficult task, chore, or instruction? What is the form of the escape behavior?

2. Are the target behaviors more likely to produce escape from the situation by an adult staff person or parent than other more appropriate behaviors to terminate the task? On what type of reinforcement schedule are they? How long do such escape behaviors sustain before the aversive or relatively lengthy task, chore, or instruction is terminated by someone?

3. Do the problem behaviors occur during tasks, chores, or assignments that are relatively difficult for the individual (an instructional mismatch)?

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assignment in whatever condition at the time, that is, difficult versus easy. If difficulty is the factor, the data should show a differential result between the two conditions.

With some children who engage in self-injury, the form of their response and intensity defies one’s sensibilities. Such episodes of protracted hitting to the face and body of severe intensity perplex both lay people and professionals. In watching an episode of protracted length and intensity, it is not uncommon for even professionals to claim that the child is biologically driven to such episodes, that is, the child’s brain is responsible, and the child is not responsible for the actions. The overriding contention is that such behavior cannot be explained by any learning conditioning history.

Can a conditioning history be the explanation for such severe forms of self-injury? Unfortunately, minor forms of self-abusive behavior are often exacerbated unintentionally over time. Over the course of several or many months, the severity of the child’s self-injury (e.g., head hitting) may intensify as a result of the parents or teachers trying to ignore the minor forms of self-abuse. These severe forms of self-injury become even more powerful in their ability to alter the environment. In addition to producing an escape from the aversive context, the possibility of such behaviors also impacts the likelihood of task demands being made (avoidance function as well). As repeated attempts to ignore some forms of self-injury are carried out by the teachers and/or parents, the requirement for the intense forms to occur and produce escape is more evident. At some point in this longitudinal process, the young girl’s repeated self-injury has left scars. Further, she has become too unmanageable for her current educational placement, and her placement is changed to a more restrictive setting. In many cases, over time, her social environment becomes more respectful of such a destructive capability that very few (if any) demands are placed on her. Also over time, her tolerance for such painful blows has been enhanced, as a result of this gradual incremental approach to powerful strikes to the face and body. If you simply observe the child after years of “practice” altering her social environment, you might conclude that she is driven by some innate mechanism to abuse herself. (There is a disorder, Lesch-Nyhan, that is hypothesized to automatically produce self-injury, but most self-injury cases have been shown to be operant behaviors.)

Difficult Tasks. Other students engage in a variety of problem behaviors that escape difficult tasks. A student may initially complain about difficult material and subsequently engage in a number of verbal complaining statements such as, “This is too hard, I can’t do this. I don’t know how to do this.” If the teacher does not provide relief by presenting an alternate activity or making that task less difficult, the complaints may increase in intensity, or new problem behaviors give rise, for example, the student gets out of his or her seat or engages in disruptive behavior with other students. Of course, such behaviors are immediately effective in temporarily halting the student’s engagement with the assignment. It is important to note that the student’s initial complaining of the difficulty of the task was not reinforced. Therefore, the student had to engage in other (more serious) behaviors in order to produce the desirable result: escape from the difficult assignment.

ACCESS TO THE CORE CURRICULUM FOR ALL?

These examples and the nature of this diagnostic category bring up an interesting question related to the current vogue of placing many special needs students in the core curriculum as a preferred practice. What this function presents as a probable outcome is the following: Presenting instruction and assignments that are grade levels above a student’s current level of functioning is often a prescription for serious behavior problems. In light of that, does a decision to place a student on the general education curriculum affect how he or she will behave in class? You bet! Instruction and behavior are intertwined. When students are incompetent at the material, such is an existent condition that breeds behavior problems, irrespective of where the child is served. Hopefully this makes people reevaluate the “mainstreaming at all costs” philosophy. Looking good and doing good can be two distinct entities!

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Difficult Chores. Difficulty can also be the factor if the task is not accomplished in a fluent manner. For example, I used to dread changing my car’s oil back in the 1970s (before there were plenty of shops and garages that do such for a reasonable price). The aversion of the task was not in the lack of accuracy on my part. I eventually got the new oil filter and oil into the engine. It was the fact that it took over an hour to do such, with errors that had to be corrected along the way. Such a job for someone who is accomplished at changing the car’s oil probably completes it within 10 to 15 minutes. Both accuracy and fluency are variables involved in judging the difficulty of a designated task or chore. Students who use their fingers or manipulatives can perform multiple digit addition/subtraction problems. But it takes them a far greater amount of time to do 20 problems than students who have memorized the facts. Such a tedious approach to this assignment makes it aversive; memorizing the facts would result in these assignments no longer producing a motivational condition of significant aversion (hopefully math educators are reading this!).

Let us say a client in a female residential treatment program engages in loud tantrum behavior every morning when she is asked to make the bed. Such behaviors do not occur for afternoon chores such as taking out the garbage, or even vacuuming, which she likes. However, making her bed is always a headache for her and staff, who have to prod her through it. One program staff person suggested that she might have problems with bed making because it was a chore done in the morning. Perhaps she is not a morning person! They then changed the time she could make her bed to the afternoon. This solution had no effect on the rate or severity of the tantrum behavior. In examining the client’s performance of this task, she often required corrective prompts on many of the aspects of making a bed, such as the corner tuck and straightening out the bed sheet. Bed making took her twice as long as it should have because she frequently had to correct the errors she made. Could this be why bed making is so aversive to her? It is not that bed making is a morning task, rather it is the difficulty of the bed-making chore. Once the client becomes more adept at making the bed (accuracy and fluency), the behavior problems will decrease. As difficulty decreases (due to effective teaching), so do problem behaviors.

SME 4.4: Aversive Physical Stimuli/Events. The questions in Table 3.18 should be posed when considering this diagnostic subcategory. This function involves a reliable relation between the problem behavior and the escape or avoidance of the aversive physical stimulus (Question 1). Other more acceptable behaviors are less likely to result in escape (Question 2). Although the target problem behaviors may have to occur at some frequency or duration (Question 3), they are more successful at terminating the undesired condition than other more acceptable behaviors (Question 2).

Here’s Something You Cannot Ignore! A previous example illustrated how some clients rip off their clothes to directly terminate an aversive stimulus. In this example, let us stipulate that staff are fairly efficient at chain interruption, thereby blocking direct

TABLE 3.18 n QUESTIONS TO CONSIDER FOR AN SME 4.4 DIAGNOSIS

1. Is there a reliable, somewhat frequent, relation between the problem behavior and removal of the aversive stimulus? What is the form of the escape behavior? What is the relative aversive physical condition?

2. Are the target behaviors more likely to produce an SME from the physical stimulus than other more appropriate behaviors? On what type of reinforcement schedule are they? How long or frequently do such escape behaviors sustain before the aversive stimulus is terminated by someone?

3. Does the problem behavior occur in the presence (or impending presence) of the aversive physical stimulus?

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attempts to rip off clothes and receive new clothes. Similarly, requesting different clothes falls on deaf ears. However, when this hypothetical client urinates in his or her pants, guess what happens? The client is cleaned up and gets new clothes. Because staff cannot allow the client to remain in soiled clothing for very long, what behavior is functional in getting new clothes? Soiling one’s clothes!

HOW DOES ONE TRANSLATE BEHAVIORAL ASSESSMENT DATA INTO A FUNCTIONAL CLASSIFICATION CATEGORY?

How does a professional evaluate the different sources of data collection to come up with a diagnostic classification of the target problem behavior? There are no hard and fast rules. In Chapter 2, we presented and rated the accuracy of the different methods of collecting functional analysis data. Therefore, depending on which data source is available, the professional evaluates the data, looking for evidence of a certain function.

It seems to us that in some cases, diagnosing a problem behavior is an iterative process. You may initially surmise that screaming, in the case of a client who refuses to do a chore, is SME 4.2: Lengthy Tasks/Chores/ Assignments. However, after an analogue assessment, the data do not bear that out. There were insignificant differences between long- and short-duration chores. Further, evidence brings you to suspect that adult attention is the culprit. Using a descriptive focused analysis reveals that such screaming brings hugs and praise from the staff as well as an occasional tangible reinforcer if the client promises that to be good and do the chores. It also reveals that other behaviors are not successful in getting hugs. Hence, the differential diagnosis more pertinent is either (or both) SMA 2.1: Adult Attention or SMA 2.3: Tangible Reinforcer.

As you can see, it is a lot like playing detective. Unfortunately, there is not an algorithm for determining functions of problem behavior. Although analogue assessments, trigger analysis, and in-vivo hypothesis testing will reliably give you the best information, we believe it is up to the behavior-analytic clinician to put the evidence together and come up with a best fit hypothesis.

MULTIFUNCTIONAL BEHAVIOR The diagnostic categories in this chapter illustrate how different behaviors can serve different purposes. However, just as different behaviors can serve the same function, so too can one behavior (or topographically similar) serve different functions. Under some antecedent conditions, a particular behavior can serve a given environmental function. However, under other antecedent conditions, the same behavior serves a different function.

Perhaps a chart can illustrate how the same behavior in form can serve different environmental functions (Table 3.19). Let us use a hypothetical female client in a day treatment program for adults with varying types of developmental disabilities. This client engages in aggressive behavior under several different contexts, with different motivational conditions present.

Aggression can exert such a powerful effect on the social environment that it can be the most efficient behavior in some people’s repertoire under a variety of EOs. It can be efficient at producing adult attention in some circumstances, whereas it can also be adaptive when the person wishes to access some tangible reinforcer under conditions of deprivation. Further, it occurs under varied aversive contexts and effectively functions to escape or avoid such.

In Table 3.19, note that one function of this client’s aggressive behavior is SMA 2.3. In the morning, she hits staff when it is time to put her clothes on. The aggressive behavior

3 The Cipani Behavioral Classification System 133

toward staff occurs after she and they have argued for some time about wearing the clothes selected for her by the morning staff. Hitting occurs when staff attempt to get her to dress, following some period of arguing, with the selected clothes. On some occasions, when the client hits, some staff will let her choose which clothes to wear if she promises not to hit them again. The differential diagnosis for this client’s aggressive behavior would be SMA 2.3: Tangible Reinforcer. When she cannot select her favorite clothes to wear in the morning, she is more likely to hit staff. Further, hitting is a behavior that intermittently results in getting the desired clothing. Aggression appears to serve a socially mediated function under this condition.

This client also has some frequency of being noncompliant with staff around chores. The contingency for noncompliance is a brief time-out. Aggression also occurs in this context. When placed in the time-out chair, she will sometimes leave the time-out chair to hit the residential staff. In other cases, staff get hit by her on the way to the time-out chair. Under the conditions of time-out, aggressive behavior is illustrative of subcategory SME 4.1: Escape From Unpleasant Social Events. The client’s aggression will be maintained when being placed in time-out given two factors: (a) such behavior temporarily postpones the advent of the time-out (as they struggle to get her to the chair) and (b) such behavior reduces the likelihood of such a social consequence, that is, time-out, being used in the future (avoidance function).

For this particular client, the intervention for the target problem behavior will depend on the context that is existent when aggression occurs. If the context is the absence of a desired item (i.e., SMA 2.3), the contingency for aggression will be different than if aggression occurred in response to the implementation of a time-out. Such functional treatment strategies will be delineated in Chapter 4.

Diving Onto the Floor. Roy was a 48-year-old man who had been residing in locked psychiatric treatment centers for several years prior to his admission to Keven Schock’s facility. He had also briefly lived in several different care homes, none for longer than 3 months. He had numerous problematic behaviors, including making delusional statements, elective mutism, and catatonia. One of the primary reasons for his discharge from the group homes, however, was diving on the floor and refusing to get up. On some occasions, he injured staff by diving into them.

Once he arrived at Keven’s facility, the staff and Keven observed that sometimes he would dive to the floor and pretend to be asleep. In these incidences, he would lie on the floor while ignoring staff requests, until staff left the area. He would then immediately get up and engage in his usual activities. Certainly such incidents seemed to be escape from some aversive event that staff were presenting. However, there were other times when he seemed to desire their attention. On these occasions, once the staff left the area he would get up, run full speed, and dive headfirst into the nearest staff person’s feet. In one scenario, it appeared that the diving on the floor functioned to escape demands, but in the other scenario it appeared to function to access staff attention. Except for the result of the latter being diving into a specific person, the topography of each type of scenario was that of diving on the floor.

Keven ruled out the possible physical result of the behavior (i.e., the physical sensation obtained when skimming across the floor), as the controlling contingency. Keven and the staff focused on an analysis of the socially mediated effects of the diving behavior. Hence the A-B-C data in Table 3.20 reports only socially mediated effects.

TABLE 3.19 n ILLUSTRATIONS OF MULTIPLE FUNCTIONS OF AGGRESSIVE BEHAVIOR

Target Behavior DA Functions SMA Functions DE Functions SME Functions

Aggression to others

None Access to tangible reinforcers (SMA 2.3)

None Escape from social punishment (SME 4.1)

DA, direct access; DE, direct escape; SMA, socially mediated access; SME, socially mediated escape.

134 Functional Behavioral Assessment, Diagnosis, and Treatment

Keven and the staff repeated the A-B-C descriptive analysis of the diving behavior across several days. On some occasions Roy would simply lie on the floor for a short time, then get up and resume his activities. However, during some of the observations, after lying on the floor for a short period of time he would get up, run full speed, and dive into a staff person. Diving into a person was always preceded by diving to the floor, but not every event of diving to the floor was followed by diving into a person.

The descriptive observation data Keven and his staff collected appeared to support two different functions for diving to the floor. One function appeared to be escape from an uncomfortable event or unpleasant task. For example, requests by staff to have his blood pressure checked, requests to attend therapy in groups, and requests to talk with a social worker, doctor, or anyone he did not already know all routinely resulted in a dive to the floor. Under this set of conditions he was likely to get off the floor quickly if the staff left the area and did not repeat the prompt.

The other function appeared to be to access staff attention. The staff noted that the behavior of diving into a staff person revolved around the number of prompts given to get up. If staff repeatedly prompted him to get up and attempted to talk with him while he was on the floor, he would sometimes get up and return to his previous activity. However, if staff delivered a single prompt to get up and then left the area, he seemed more likely to get up and dive into people.

Given the need to quickly and very accurately determine the function of this behavior, they tested the staff observations by conducting an experimental analysis. They developed three test conditions. One condition was in effect each day. The conditions were presented sequentially until each had been in place four times. One trial consisted of exposure to all three conditions. In order to expedite the assessment process, they collected data on two different behaviors in each condition. The first behavior was diving to the floor. The second behavior was diving into people. This design allowed them to simultaneously test both behaviors across three conditions.

In the first condition, staff tested the effects of task demand. In this condition the value of staff attention was kept at low levels by providing staff attention to Roy about every

TABLE 3.20 n DESCRIPTIVE ANALYSIS FOR “DIVING” BEHAVIOR

A B C

9:45 a.m. Sitting in day room; no staff interaction for 45 min

Got up, walked toward staff, dove onto floor at their feet

Staff walked away

10:00 a.m. Lying on floor; staff in next room

Got up, ran into other room, and dove into staff person

Multiple staff intervene to direct him away from the staff he dove into and talk with him Physical contact with staff person

10:15 a.m. In medication area staff asks him to sit in chair to take his blood pressure

Dove to floor and closed his eyes

Staff prompted him to get up and then left the area

10:20 a.m. Lying on floor; no one close by

Gets up and goes to day room and sits down

No demand; no staff interaction Back to sitting in day room

10:25 a.m. Sitting in day room. Staff asks him to come get his blood pressure taken

Dives to the floor and closes his eyes

Staff prompt him to get up and then leave the area

3 The Cipani Behavioral Classification System 135

15 minutes independent of any behavior on his part. The value of escape from task demands was established by a second staff making requests for Roy to complete tasks that had been associated with diving to the floor during the A-B-C data collection. In this condition, if Roy dove to the floor the staff making demands would leave, and the staff providing attention would continue talking with him as if the behavior had not occurred. A high rate of diving to the floor, and not diving into people, would support the contention that the function of the behavior is escape from relatively unpleasant tasks. Conversely, a low rate would tend to rule out that it functioned to produce escape from relatively unpleasant task demands

In the second condition, Keven and the staff tested the effects of deprivation of staff attention. In this condition, the value of escape from task demands was kept at low levels by ensuring no requests or demands were presented to Roy during the session. The value of staff attention was established by staff avoiding any unnecessary interaction with Roy. In this condition, if Roy dove to the floor the staff would continue to ignore the behavior and still make no demands. If he attempted to dive into staff, the behavior would be blocked and Roy would be redirected to another area. A high rate of diving into people would provide support for an attention function for this topography.

In the third condition, they set up a control condition for both attention and unpleasant tasks by ensuring that the establishing operation for both was minimal or nonexistent. In this condition, the value of escape from task demands was kept at low levels by ensuring no requests or demands were presented to Roy during the session. The value of staff attention was kept at low levels by providing staff attention to Roy continuously, independent of any behavior on his part. If Roy dove to the floor, the staff would continue to provide noncontingent attention and still make no demands. If he attempted to dive into staff, his behavior would be blocked and redirected to another area, and the noncontingent delivery of attention would continue.

A low rate of both diving behaviors would indicate that the motivating variables were a deprivation of attention (diving into people) and unpleasant tasks (diving on the floor). If such were the case, Keven would have possibly revisited the hypothesis of a direct reinforcement function. Table 3.21 shows the rate of occurrence of diving to the floor and diving into people as a function of each test condition.

A review of the data for condition one indicated that although he did dive on the floor, he did not dive into people. Because they had reduced the value of staff attention by providing it noncontingently in this condition, they could be reasonably sure that diving on the floor did not result in an increase in staff attention. This data provided support for the hypothesis that diving onto the floor was not maintained by staff attention. Given that there was a high level of demands in this condition, we had reasonable evidence that escape was a maintaining function of diving to the floor. Additionally, when the demand was removed contingent on diving to the floor, Roy stood up and returned to his previous activity.

The data from condition two require a bit more explanation. In condition two, Keven and his staff reduced the value of escape from demands by ensuring that no task demands were

TABLE 3.21 n RATE OF DIVING BEHAVIOR ACROSS CONDITIONS

Condition 1—Task Demands and

Noncontingent Staff Attention

Condition 2—No Task Demands and No Staff

Attention

Condition 3— Noncontingent Staff

Attention and No Task Demands

Diving on the floor

Diving into people

Diving on the floor

Diving into people

Diving on the floor

Diving into people

Trial 1 2 0 1 1 0 0

Trial 2 3 0 2 2 0 0

Trial 3 1 0 1 1 0 0

Trial 4 4 0 1 1 1 0

136 Functional Behavioral Assessment, Diagnosis, and Treatment

made. They increased the value of attention by not interacting with him. In this condition, they were reasonably sure that the diving to the floor and diving into people were not maintained by escape. In each of the trials, diving into people appeared to be the second part of a chain of behavior that started with diving on the floor and then, after some short period of time, he would get up and dive into a staff person. In this condition, diving to the floor was never followed by simply getting up and returning to his usual activity. A return to his usual activity occurred only after some level of staff interaction. In the third condition, the zero rates of both of the targeted behaviors provide evidence that attention and escape accounted for all of the occurrences of both topographies of the diving behaviors and that diving was not maintained by direct reinforcement.

Keven and the staff made the following conclusions based on this test data.

1. When Roy was asked to do tasks (even when already receiving attention) he would dive to the floor and remain there until the staff presenting the demand left the area. He did not dive into other people. The result was the demand was removed. (Escape function)

2. When Roy was not asked to do a task and staff did not interact with him, he would dive to the floor, and when staff continued to ignore him he would eventually get up and dive into the nearest staff person. The result was an increase in attention. (Attention function)

3. When they made no demands and talked with him he did not dive to the floor and did not dive into people. The diving behaviors did not occur when attention was already available and no demands were presented. (Ruled out direct reinforcement as maintaining contingency—possible sensory effects produced by grinding body against floor.)

Probably of greatest practical significance, the data from the third condition generated an effective temporary intervention to immediately reduce both topographies of the diving behavior while Keven and the staff developed a plan to teach Roy more acceptable behaviors to escape demands and access staff attention.

DISCUSSION QUESTION 3H

1. Why would a behavior that has both SMA and SME functions be difficult for staff to treat?

2. How would you make it easier for the staff to discriminate which motivating condition (EO) was at sufficient strength at any given moment?

SUMMARY There are four major function-based diagnostic classifications of problem behavior in the Cipani BCS. DA behaviors are maintained at high levels because they directly access the positive reinforcer. SMA problem behaviors produce a positive reinforcer indirectly, through the behavior of another person. DE behaviors remove or avoid aversive events directly. SME problem behaviors remove or avoid aversive events or conditions indirectly, through the mediation of another person’s behavior.

Within each major category, there are subcategories reflecting the same functional relationships as the major category. The subcategories delineate specific reinforcers, such as access to adult attention under SMA functions or escape from difficult tasks under either DE or SME functions. The Cipani BCS can be of great utility to determine the specific functional treatment strategy for the problem behavior.

3 The Cipani Behavioral Classification System 137

Notes 1. While there are studies that show various behavioral treatments work for children with

certain disorders, such does not constitute proof that those treatments work only for that particular disorder, for example, response cost contingencies are effective only for clients with ADHD. In point of fact, the effectiveness of specific behavioral contingencies rests on the behavior-environment arrangement that is affected by the treatment as being of relevance to the current function of the target problem behavior.

2. This should not be conducted unless written consent is obtained from guardians as well as administrative personnel at the site. Additionally, and just as important, obtain medical clearance for the potential welfare of the client if she or he ingests a few cigarette butts in one session. Also, if you conduct this test, designate a limit in which the assessment will be halted (e.g., after the second ingestion).

SELF-ASSESSMENT EXERCISES

• Generate problem behaviors found in school, home, or community settings that reflect both SME and SMA functions. Delineate what the EO condition is, and how the problem behavior is efficient in producing an abolishing condition, that is, relevant reinforce.

• Generate problem behaviors found in school, home, or community settings that reflect both DE and DA functions. Delineate what the EO condition is, and how the problem behavior is efficient in producing an abolishing condition, that is, relevant reinforce.

• A classic study by Solnick et al. (1977) examined the effectiveness of timeout. The researchers found that time-out did not decrease the target behavior. Explain why the 6-year-old girl with autism exacerbated her level of tantrum behavior, to produce the programmed contingency of time-out.

• See the hypothetical example of a DA 1.2 function regarding food scavenging in this chapter (see Food Scavenging!). Explain why such behavior is a DA function. Can food scavenging also be maintained by a socially mediated function? Explain how such a behavior might serve an attention function. How is the EO different in the DA case versus the attention function?

• Discuss the case of a hypothetical student, Dolly, and how some appropriate behaviors do not result in attention while an inappropriate behavior does.

• The real-life case (see Elopement) of how eloping from the facility resulted in this client getting soda is quite unique. Explain how such a function, especially in light of the establishing operation, is an example of an SMA 2.3 function.

• He Likes to Be Restrained provides the case of an individual in which all staff said that the function of his problem behavior was getting people to restrain him. What was the maintaining contingency? Explain why the restraint was a requisite for getting this reinforcer.

• How does Running Away From the Facility meet a DE 3.1 function-escape from unpleasant social situations?

• What is the “wacky contingency”?

• Explain how an instructional mismatch creates a contextual condition under which escape behaviors become likely.

• Explain the case of Shut Up and Leave Me Alone! Found on page 170

• The hypothetical case of a student, “I’m Bored,” is presented. Why does this child engage in property disruption?

138 Functional Behavioral Assessment, Diagnosis, and Treatment

3. If you have special needs students who have significant problem behaviors during standardized testing, consider that such a context involves no breaks between sections and encountering difficult material as possible EOs for such behavior.

4. For an explanation of why some children with ASD have difficulty with instructional tasks, the reader is enjoined to read Appendix B: Why Artie Can’t Learn!

REFERENCES Caudery, G. E., Iwata, B. A., & Pace, G. M. (1990). Effects and side effects of DRO as treatment for self-injurious behavior. Journal of Applied Behavior Analysis, 23, 497–506. Cipani, E. (1990). The communicative function hypothesis: An operant behavior perspective. Journal of Behavior Therapy and Experimental Psychiatry, 21, 239–247. Cipani, E. (1994). Treating children’s severe behavior disorders: A behavioral diagnostic system. Journal of Behavior Therapy and Experimental Psychiatry, 25, 293–300. Cipani, E. (2014). Co-morbidity in DSM childhood mental disorders: A functional perspective. Research in Social Work Practice, 24, 78–85. Cipani, E., & Cipani, A. L. (2017). Behavioral classification system for problem behaviors in schools: A diagnostic manual. New York, NY: Springer Publishing. Cipani, E., & Schock, K. (2007). Functional behavioral assessment, diagnosis, and treatment: A complete system for education and mental health settings. New York, NY: Springer Publishing. Cipani, E., & Schock, K. (2011). Functional behavioral assessment, diagnosis, and treatment: A complete system for education and mental health settings (2nd ed.). New York, NY: Springer Publishing. Iwata, B. A., Dorsey, M. F., Slifer, K. J., Bauman, K. E., & Richman, G. S. (1982). Toward a functional analysis of self-injury. Analysis and Intervention in Developmental Disabilities, 2, 3–20. Mason, S. A., & Iwata, B. A. (1990). Artifactual effects of sensory-integrative therapy on self- injurious behaviors. Journal of Applied Behavior Analysis, 23, 361–370. Schock, K., Clay, C., & Cipani, E. (1998). Making sense of schizophrenic symptoms: Delusional statements may be functional in purpose. Journal of Behavior Therapy and Experimental Psychiatry, 29, 131–141. Skinner, B. F. (1957). Verbal behavior. New York, NY: Appleton-Century-Crofts. Solnick, J. V., Rincover, A., & Peterson, C. R. (1977). Some determinants of the reinforcing and punishing effects of time out. Journal of Applied Behavior Analysis, 10, 415–424. Switzer, E. B., Deal, T. E., & Bailey, J. S. (1977). The reduction of stealing in second graders using a group contingency. Journal of Applied Behavior Analysis, 10, 267–272. Vargas, E. A. (1988). Event-governed and verbally governed behavior. Analysis of Verbal Behavior, 6, 11–22. Vaughn, M. E., & Michael, J. (1982). Automatic reinforcement: An important but ignored concept. Behaviorism, 10, 217–227.

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4Function-Derived Treatment Options

Objectives

• Students will be able to identify functional treatment options for the DA 1.1 and 1.2 functions, and detail the procedures for the conduct of such with respect to the designated functional category

• Students will delineate the role of chain interruption for DA and DE functions

• Students will be able to identify functional treatment options for the SMA 2.1, 2.2, and 2.3 functions, and detail the procedures for the conduct of such with respect to the designated functional category

• Students will delineate the role of extinction for SMA and SME functions

• Students will be able to identify functional treatment options for the DE 3.1, 3.2, 3.3, and 3.4 functions, and detail the procedures for the conduct of such with respect to the designated functional category

• Students will be able to identify functional treatment options for the SME 4.1, 4.2, 4.3, and 4.4 functions, and detail the procedures for the conduct of such with respect to the designated functional category

• Students will be able to conduct a trigger analysis to assess the possible severity of an extinction burst

• Students will be able to identify the three classification categories in the Cipani Replacement Function Classification System for replacement functions, and contrast them with the diagnostic criteria for each

• Students will be able to conduct an experimental analysis with two designated conditions to determine if a selected behavior for the replacement function is currently at minimal rate due to misdirected contingencies or inept repertoire

Chapter 4 Behavior Analysis Certification Board (BACB) Task List

4th edition 5th edition • J-02 Identify potential

interventions based on assessment results and the best available scientific evidence

• G-1 Use positive and negative reinforcement procedures to strengthen behavior.

• G-2 Use interventions based on motivating operations and discriminative stimuli.

(continued )

140 Functional Behavioral Assessment, Diagnosis, and Treatment

This chapter will examine how to select and design a function-derived treatment. The designation of the treatment requires two contingency considerations. First, the function of the problem behavior should be significantly hampered and disabled. Concurrently, the replacement function involves an alternate behavior(s) that should be enabled under a specified establishing operation (EO). The latter contingency design features are often referred to as the “replacement behavior.” These two sets of considerations will be presented for each of the major categories. A number of potential treatment options will be posed for the four major functions: direct access (DA), socially mediated access (SMA), direct escape (DE), and socially mediated escape (SME). Throughout this chapter, a “text box” is used to highlight the basic rearranged contingencies for treating a problem behavior and its function with the selected treatment option. Finally, a three-category diagnostic system to determine the strength of the behavior(s) to serve in the replacement function will be presented.

4th edition 5th edition • J-04 Select intervention

strategies based on client preferences

• J-05 Select intervention strategies based on the client’s current repertoires

• J-06 Select intervention strategies based on supporting environments

• J-10 When a behavior is to be decreased, select an acceptable alternate behavior to be established or increased

• D-06 Use chaining

• D-11 Use mand training

• D-21 Use differential reinforcement (e.g., DRO, DRA, DRI, DRL, DRH)

• D-18 Use extinction

• E-10 Use the Premack principle

• I-04 Design and implement the full range of functional assessment procedures

• I-05 Organize, analyze, and interpret observed data

• I-06 Make recommendations regarding behaviors that must be established, maintained, increased, or decreased

• G-3 Establish and use conditioned reinforcers.

• G-7 Use shaping.

• G-8 Use chaining.

• G-9 Use discrete-trial, free-operant, and naturalistic teaching arrangements.

• G-14 Use reinforcement procedures to weaken behavior (e.g., DRA, FCT, DRO, DRL, NCR).

• G-15 Use extinction.

• H-1 State intervention goals in observable and measurable terms.

• H-2 Identify potential interventions based on assessment results and the best available scientific evidence.

• H-3 Recommend intervention goals and strategies based on such factors as client preferences, supporting environments, risks, constraints, and social validity.

• H-4 When a target behavior is to be decreased, select an acceptable alternative behavior to be established or increased.

• H-5 Plan for possible unwanted effects when using reinforcement, extinction, and punishment procedures.

• H-6 Monitor client progress and treatment integrity.

• H-7 Make data-based decisions about the effectiveness of the intervention and the need for treatment revision.

• H-8 Make data-based decisions about the need for ongoing services.

• H-9 Collaborate with others who support and/or provide services to clients.

(continued )

4 Function-Derived Treatment Options 141

WHAT IS A REPLACEMENT BEHAVIOR? When treating problem behaviors, one must decrease the target unacceptable behaviors while selecting an alternate desirable behavior, termed a replacement behavior, for specific reinforcement. A replacement behavior serves the same environmental function as a problem behavior. Therefore, a replacement behavior cannot be designated without an understanding of the target behavior’s function under specific antecedent contexts (EO & discriminative stimuli). The selected replacement behavior must be capable of producing the same reinforcer as the problem behavior in the identified contexts. The hypothetical example depicted in Table 4.1 illustrates how an alternate, more appropriate form of behavior can replace the current function of the problem behavior.

The designation of the three possible replacement behaviors in Table 4.1 stipulates that each replacement behavior must result in the delivery of the reinforcer. For example, in the first replacement behavior, requesting the toy (from another child) must produce the desired toy at some high level of probability. One cannot simply announce that requesting behavior is an alternate replacement behavior for this child instead of grabbing a toy. Without ensuring that reinforcement will ensue for requesting the toy, the target behaviors may still be more functional than the current designated means for obtaining reinforcement. If the requests are not honored reliably, requesting behavior will not function effectively to access reinforcement.

TABLE 4.1 n EXAMPLE OF ALTERNATE REPLACEMENT BEHAVIORS

Problem Behavior: Under the conditions of wanting a toy that another child is using, the target child gets the toy from the other child (consequence) by grabbing the toy (behavior problem) and running away with the toy (DA 1.2: Tangible Reinforcers).

Goal: Decrease the target inappropriate behavior, which is, grabbing the toy from someone else and running away with the toy. Increase an alternate appropriate behavior given the same context.

Possible Appropriate Replacement Behaviors:

1. Requesting toy Desired Contingency: Child gets the toy from another child (consequence) by asking nicely if he can play with the toy, and other child gives the toy upon request. The request needs to be honored for such a replacement behavior to be naturally maintained. Further, grabbing the toy results in loss of access to the toy immediately, by adult removing the child from the toy and play area.

2. Offering to play together Desired Contingency: Child shares the toy with another child (consequence) by asking nicely if he or she can play with the toy with that child. The request to share the toy needs to be honored for such a replacement behavior to be naturally maintained. Again, grabbing the toy results in loss of access to the toy immediately, by adult removing the child from the toy and play area.

3. Getting another toy, while waiting for the desired toy to become available Desired Contingency: Adult specifies time period each child wanting a certain toy will have, e.g., 2 minutes. The target child waits or gets another toy during the interim period. When it is his or her turn to play with the desired toy, he or she is given access by adult requiring the other child to relinquish the toy, and the target child gets a certain amount of time with the toy, e.g., 2 minutes.

142 Functional Behavioral Assessment, Diagnosis, and Treatment

Requesting then becomes a less probable behavior under these circumstances. Meanwhile other behaviors will be exhibited in attempts to get the toy.

Further, the prior functional target behavior, that is, grabbing the toy from another child, must not be allowed to succeed. Such behavior, when exhibited, must result in immediate removal of the toy from the target child. Further, the loss of access to that toy (and others) for a period of time must be invoked. This contingency for grabbing behavior must be in place in order for any potential replacement behaviors to have a chance at becoming functional. Allowing this child to grab a toy from another child without such a contingency dooms the development of alternate behaviors to failure. The removal of the toy must be immediate! If the adult argues with the child, this contingency is considerably weakened, and grabbing toys from other children becomes strengthened relative to more appropriate behaviors.

Similarly, sharing the toy upon request (second example) must also be honored if it is going to take the place of grabbing a toy. Further, the target child’s enjoyment of the sharing of the toy must parallel the reinforcing magnitude of playing with the toy in isolation. Sharing versus playing alone, even with the same toy, are not the same events. Hence, the reinforcing potency of the sharing context needs to be evaluated as being as powerful as playing alone. If it is not as pleasurable, engaging in a request to share will probably not replace grabbing the toy.

Finally, teaching the child to wait for a period of time before getting the desired toy will be effective only if grabbing the toy never (or rarely) produces access to the toy. Therefore, the previously stipulated contingency for toy grabbing must be in place. In addition, the ability to delay gratification often needs to be systematically developed. This plan would probably require a progressive manner of teaching “waiting behavior.”

Suppose access to a toy was achieved through an adult via tantrum behavior (i.e., instead of grabbing the toy)? The diagnostic category for this target behavior is SMA 2.3: Tangible Reinforcer. What might be some of the options for an alternate replacement behavior? Table 4.2

TABLE 4.2 n EXAMPLE OF ALTERNATE REPLACEMENT BEHAVIORS FOR TANTRUM BEHAVIOR

Problem Behavior: When the child desires a toy that someone else has, the child gets the toy from the caregiver (consequence) by throwing a tantrum for several minutes (behavioral problem).

Goal: Decrease the target inappropriate behavior, i.e., tantrum behavior. Increase an alternate appropriate behavior given the same context.

Appropriate Replacement Behaviors:

1. Request toy from caregiver Desired Contingency: The child is given the toy by the caregiver (consequence) after an appropriate request is made for the toy. The request needs to be honored for such a replacement behavior to be naturally maintained. Further, if the child engages in tantrum behavior, such results in a period of time where the desired toy is made not available. (Note: This program should also be supplemented with a delay of gratification training option, to be presented in this chapter.)

2. Finish task or chore first Desired Contingency: The child is given the toy by the caregiver (consequence) after the child completes the task or chore assigned (Premack contingency). Completing the chore needs to be honored as the requisite event for accessing the toy. Further, tantrum behavior sets up a period of time whereby the desired toy is not available.

4 Function-Derived Treatment Options 143

illustrates two possible alternate replacement function options for the designated SMA function of the target behavior of tantrums, that is, access to the toy. In the first option, an appropriate request will replace the tantrum behavior in terms of toy access function. If the child throws a tantrum, he or she does not get the toy. If the child requests the toy in an appropriate tone of voice, he or she gets the toy.

In the second option, performing a required task or chore is a conditional event prior to getting the toy. It is again essential that completion of the task results in accessing the toy, while ensuring that the tantrum behavior does not produce the toy (or minimally, produces the toy less effectively and efficiently than completing the chore; see Table 4.2). Note how both examples select an alternate appropriate behavior that can serve the same function (i.e., produce the same reinforcer) as the problem behavior. Once the replacement behavior is developed in the client’s repertoire, it will replace the function or purpose of the problem behavior. This will occur only if the dual contingency exists: The replacement behavior achieves reinforcement, while the target problem behavior is significantly less functional, or nonfunctional, in achieving the desired result. Table 4.3 presents the steps to utilize in identifying a functional replacement behavior.

DISABLE ONE FUNCTION, ENABLE ANOTHER Too often, many inexperienced attempts at developing a replacement behavior involve simply specifying that some selected behavior should replace the target behavior. People who espouse such declarations do not seem to grasp or comprehend the nature of behavior with respect to antecedent and consequent stimuli. To accomplish the successful transition from a currently functional target problem behavior becoming nonfunctional and a currently nonfunctional appropriate behavior becoming functional, social control over the maintaining contingencies is required!

Target behavior Eliminate or disable current function Replacement behavior Enable and enhance desired environmental function

For example, a referral is made for a male client who hits people on the shoulder while sitting on the couch and watching TV in a group home for persons with disabilities. One of the program managers decides that the replacement behavior should be the following: have this client put his hands in his pockets while he is on the couch. That certainly sounds good because it is a state of affairs that is incompatible with hitting people on the couch. However, it offers little in the way of understanding why the hitting behavior occurs (i.e., maintaining contingency under a specific EO). Suppose the hitting occurs because the person next to the target client is talking, and hitting him makes him shut up. Is it reasonable to expect this client will keep his hands in his pockets the next time his listening to the TV program is interrupted? I believe the hands will come out of the pocket and deliver the shot that produces cessation of talking from his neighbor. Then the hands will probably go back into the pockets.

TABLE 4.3 n THE STEPS TO IDENTIFYING REPLACEMENT BEHAVIORS

• Identify the diagnostic category of problem behavior by assigning it to one of the four major diagnostic categories (and sub-categories) presented in Chapter 3.

• Identify the specific reinforcers that result from the occurrence of the problem behavior (Chapter 3), under the prevailing motivational conditions (EOs) and antecedent contexts.

• Designate an alternate appropriate behavior(s) or behavioral criteria that will be made to produce the same function as the problem behavior in the identified antecedent social contexts, whether naturally or contrived.

• If the problem behavior serves more than one function, identify the different functions for each antecedent context and repeat above steps for each unique source of stimulus control.

144 Functional Behavioral Assessment, Diagnosis, and Treatment

In summary, the behavior analyst needs to produce two changes in the client or child’s environment. First, the target behavior’s current function needs to be disabled or severely impaired by manipulating those current maintaining contingencies (i.e., function). Equally important, the alternate appropriate behavior needs to be enabled in producing the desired environmental function previously produced by the target behavior under relevant motivational conditions.

In this chapter, we present several replacement function options for developing an alternate manner of producing the desired result (i.e., abolishing operation). Determining what the maintaining contingencies are for the problem behavior as well as the current strength of the potential replacement behavior is at the heart of designing an effective functional treatment. The following material presents several functional treatment options for each major diagnostic category for problem behavior: DA 1.0, SMA 2.0, DE 3.0, and SME 4.0. Of course, removal of the problem behavior’s maintaining reinforcer is implicit within each of these options.

REPLACEMENT FUNCTION OPTIONS FOR DA PROBLEM BEHAVIORS There are four replacement function options when treating a target problem behavior that is maintained by to directly contacting the positive reinforcer. In some parts of this chapter, we have slightly altered the term, “replacement behavior,” to embrace a synonymous term, “replacement function.” Some of the options presented below do not have a distinct “replacement behavior.” Rather the intervention strategy produces the desired outcome when a behavioral criterion or standard is achieved, which may involve the absence of the problem behavior (e.g., delay of gratification training). This modification allows the designated term to encompass a desired function rather than identifying just a behavior. All four options require the chain interruption strategy as a component to address client attempts to actually engage in the prohibited target behavior, when unauthorized.

Alternate DA form replacement option: Identify an alternate, more acceptable form of behavior (one that is not as inappropriate or dangerous) that directly produces the same specific reinforcer.

Access mand (request) replacement option: Identify a requesting behavior (mand) that would allow staff to mediate such a request or choice by providing the client with a more appropriate setting (area) in which to engage in the problem behavior (if the problem behavior is not dangerous, but is merely inappropriate in form).

Delay of gratification training option (differential reinforcement of other behavior [DRO]): Identify a length of time that you want the individual not to perform the target DA behavior, that is, the nonoccurrence of behavior for a set time period. Contingent upon the individual not engaging in the target problem behavior for that time period, access to the specific reinforcer is provided, either by request or by direction of staff (functional treatment option rather than a discrete replacement behavior).

Premack contingency replacement option (engagement in lower probability behaviors as the contingency for access to a specific reinforcer): Identify a regimen of tasks that, when completed, allows the client to access the specific reinforcer (consider this criterion for reinforcement access as a chain of sequenced performances).

Chain Interruption Strategy Chain interruption involves interrupting or blocking the performance of the behavior at its earliest onset. In conjunction with the target replacement function to develop an alternate mechanism, a chain interruption strategy as a contingency is essential for DA problem behaviors. In order for the problem behavior to be ameliorated, it must be weakened in its ability (i.e., disabled) to directly contact the sensory or tangible reinforcer.

Although many professionals espouse the deployment of developing a replacement behavior, they often overlook what must be done to behaviors that produce positive (or negative) reinforcement directly. If the client is not prevented from engaging in the DA behavior, then the

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desired sensory or tangible reinforcer is contacted ad lib. The replacement behavior option will thus be rendered less functional (i.e., less effective and efficient). As a result, the client will not engage in that designated replacement behavior to access reinforcement.

Therefore, it is essential that you interrupt the target behavior before it contacts reinforcement, or at least before a certain amount or duration of access is attained. For example, if the client is mouthing inedible objects because of the oral stimulation it produces, such a direct behavior-reinforcement relationship would need to be greatly impeded via chain interruption or blocking. Attempts to physically stop the client from placing the object in the mouth are necessary. If the client is stopped only after gnawing on the object for a while, it is too late! Sensory reinforcement has already been achieved. Impeding such a response– reinforcer relationship is critical to the success of any treatment plan.

The staff must become more vigilant in detecting the initial parts of this behavior and interrupting it. Their efforts may be met with the client becoming stealthier in engaging in this behavior. However, the effort to make such a DA to positive reinforcement function more arduous will be essential for the selected replacement behavior to become functional. The replacement behavior option must successfully access sensory reinforcement, while the target problem behavior is obstructed frequently. If staff can fulfill that requirement, the replacement behavior option will increase in frequency while the DA problem behavior will decrease.

Concurrent with the chain interruption strategy, a strategy for developing or increasing an alternate replacement behavioral function needs to be designed. Each of the following four options may be considered. In some cases, one option may be more suited for a specific context and setting than others. This needs to be a clinical decision.

DISCUSSION QUESTION 4A Why is it necessary to implement a chain interruption procedure for problem behaviors that serve DA and DE functions?

Alternate DA Form Option In some cases, it is possible to identify an acceptable replacement behavior that varies slightly in topography from the problem behavior but still produces directly the same desired result. In a prior example, a client with severe intellectual disabilities ran to the door, swung it wide open, and ran outside. The maintaining reinforcer for this inappropriate chain of behaviors was getting to go outside. A more acceptable alternate behavior can be walking out the door (not running), and then exiting with staff supervision. Engaging in any previous form of exiting would result in staff stopping the client and delaying access to outside until the behavioral form occurs. The rearranged contingencies are delineated in Table 4.4.

Suppose we determine that sticking inedible things in one’s mouth is maintained by a DA to the ingestion of edible items. A replacement behavior that alters the form to be more acceptable while maintaining the same access to the reinforcer is illustrated in Table 4.5.

The following case examples are further illustrations of the use of this replacement function option.

Pushing and Shoving. A male client was referred to me for behavioral consultation as a result of his pushing and shoving staff in order to get to the refrigerator. He lived in a residential facility with five other adults with autism. You probably think he is going into the refrigerator to get something out to eat or drink. Such was not the case. Once he opened the refrigerator, he would check to see if the lunch bags for the next day were made and placed in their correct space.

Why would he push and shove staff in order to get to the refrigerator? This behavior was the result of staff preventing him from engaging in his obsession with “checking on the lunches.” He learned to run because staff were very good at encumbering a more leisurely approach. Simply walking over to the refrigerator to check out the lunch bags would only result in his being sent back to the living room area. He thereby learned to become both quicker and more aggressive in achieving his goal of getting to the refrigerator. You can see that pushing

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or shoving staff and running past them when they were not looking was more functional in this circumstance, given the staff ’s predilection toward preventing access to the refrigerator.

The replacement behavior identified for this client was walking appropriately to the refrigerator. He was taught to engage in such behavior, with the result being unobstructed access to the refrigerator. Given his previous history, this behavior had to be prompted for a while. If he walked appropriately to the kitchen, he was allowed to open the refrigerator door and check out the sack lunches. If he ran, pushed, or shoved anyone, he would not get to open the door at that time and was required to return to the area where the running began. He was then to demonstrate the appropriate walking behavior, which resulted in his being allowed to open the refrigerator door. Of course, pushing and shoving would decrease once such behaviors only postponed his access to the refrigerator.

A Unique Sensory Reinforcer Replacing the function of the problem behavior may sometimes be difficult with a problem behavior diagnosed as DA 1.1: Immediate Sensory Stimuli. A more acceptable form that does not produce DA to the positive reinforcer will not replace the problem behavior’s function. Although you may think that the two are equivalent, in the eyes of the client they are not. Here is a case in point.

TABLE 4.5 n ACCEPTABLE FORM

Functional Treatment: DA 1.1: Immediate Sensory Stimuli

Contingency Plan for Target Behavior: If the student attempts to stick inedible items in his or her mouth, the student will be physically prevented from achieving such a result, if possible. Additionally, a 3-minute removal from environment (place him or her in a chair where access to any object is precluded) should be effected before prompting the replacement behavior. The function of this 3-minute time-out is to make such attempts less functional and more arduous in getting edible items (i.e., disabling the function).

Contingency Plan for Replacement Behavior: If the student walks over to the basket where there is food, he or she may eat in peace. This option would be considered for clients who do not have problems with weight, such as obesity.

TABLE 4.4 n REARRANGED CONTINGENCIES

Functional Treatment: DA 1.2: Tangible Reinforcer

Contingency Plan for Target Behavior (Chain Interruption): If engaging in the target behavior (running outside), the client will be stopped and brought back immediately to the start point. The client will be required to wait a period of time, for example, 1–2 minutes, before being prompted to perform the alternate behavior. Of course staff have to be close to catch any inappropriate exiting behavior immediately, upon which they will perform this regimen.

Contingency Plan for Replacement Behavior: If the student signs “out,” he or she will be allowed to go outside if walking appropriately. Student may need staff to prompt such behaviors in contrast to running, as well as massed trials of practice (if replacement behavior diagnosis is inept repertoire; see Inept Repertoire Category section of this chapter).

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In the early 1980s, a female client was referred to me for a behavioral plan for an extremely revolting and undesirable behavior. In her day treatment program, she would grab feces left in the toilet bowl from her own use or someone else’s and squish it in her hands. The first plan set up at the program was to prevent her from doing this. The day treatment aides were to restrain her from engaging in such a behavior. Unfortunately, this plan did not work to make her value the activity less. In fact, it seemed to only deprive such an event and make the motivational condition to access it stronger. Such an increased desire on the client’s part to get to the bathroom further compounded the staff ’s problem in managing her. Use of the bathroom by other clients was a signal to her that the desired activity may be available. She would then dash to the toilet to determine whether something was left in the toilet bowl from the last user. Because she was now being prevented from going to the bathroom at these times, she began to engage in aggressive and disruptive behavior toward staff when they tried to restrain her from engaging in this behavior. Further, she became more capable of discerning times when staff would be less vigilant and a mad dash to the bathroom might pay off. When another client was engaged in tantrum behavior and staff were involved in some extensive management procedure, she would dart toward the bathroom. Hence, another client’s problem resulted in staff having to deal with two problems.

My analysis of this behavior supported a DA function (DA 1.1: Immediate Sensory Stimuli). The client seemed to like the sensation of squishing the feces in the toilet bowl. I am not sure why this was pleasurable to her, but it certainly seemed that the behavior was producing its own reinforcer. The replacement behavior that was targeted for reinforcement involved the same form of the behavior. When she completed a designated number of tasks, she earned a specified amount of free time. She was then allowed to go to the bathroom and squish feces! However, prior to going to the bathroom, disposable rubber gloves were placed on her hands. She then engaged in the squishing behavior, with the gloves on. When her free time elapsed, she took the gloves off and disposed of them in the garbage can in the bathroom. She then washed her hands thoroughly before going back to the work area. She resumed her work on tasks to earn more free time. Data indicated that the rate of running to the bathroom to “check it out” reduced to zero, as did the wrestling matches with the staff. Her work production was maintained at high levels.

Why was this form chosen and not something else? Suppose we had set up a program that allowed her to squish play dough instead? That certainly would be more appropriate than squishing feces in her hands, even with gloves on. However, squishing play dough may not have resulted in the same sensory reinforcer. Therefore, allowing her access to play dough may not have been equivalent from her perspective. Hence, such a contingency may have had no effect on the rate of the target behaviors, that is, running to the bathroom unauthorized to squish feces with one’s bare hands.

In the designated plan, the form of the replacement behavior left the sensory reinforcer intact, for the most part. Despite the repugnant aspect of this behavior, the designed program had two critical effects. First, it did remove sanitary concerns in regard to the sensory maintained behavior. Second, it resulted in a reduction of the target behavior occurrence to zero for many days. Contrast this with the result obtained when staff tried to obstruct her access to the reinforcer: frequent incidents of aggression and running to the bathroom. Finally, her obsession with this ritual decreased over time until it was not something she chose to do during earned free time.

Don’t Jump! The client mentioned earlier who jumped out of his wheelchair could also have accessed floor time in another manner. If a graded platform was built, he could have been taught to hoist himself up on the top of the platform and then gradually slide down (similar to a children’s slide on the playground). This option would have been easier on the staff. Getting into his wheelchair might have been achieved by a reverse process, that is, him moving himself up the graded platform.

Access Mand (Request) Option In some cases, it may be possible to teach the individual to request permission to engage in the desired activity (a mand). A request or mand need not be vocal; it could be a manual sign or gesture, such as pointing to a symbol or picture. The only requirement on the form of the request is that it is reliably translated by the receiver of the message.

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FUNCTIONAL TREATMENT: DA 1.1: IMMEDIATE SENSORY STIMULI

Contingency Plan for Target Behavior (chain interruption) Interrupt initial chain of stereotypic behavior. Removal for several minutes from any opportunity to perform such behavior (chain interruption).

Contingency Plan for Replacement Behavior Prompt client to request (in whatever designated form) access to desired activity or event. Contingent upon request, provide client access to desired activity in a designated setting. With some behaviors diagnosed as DA 1.1 (e.g., masturbation, nose picking), the area should be private, away from others seeing the client.

This option is particularly suited where the form of the behavior is not dangerous or unhealthy but is unacceptable in some contexts. Contingent upon a request, staff can then provide an appropriate place for the student or client to engage in the behavior. For example, some stereotypic or self-stimulatory behaviors can be treated effectively by teaching the client to request (vocally or nonvocally) the opportunity to engage in those behaviors. Contingent upon this request, the staff can then direct the client to a private area. One must make sure that the request is honored by staff in a timely manner, especially in the beginning of the program. If the request is not honored, or is delayed to a significant extent, then requesting behavior will not be functional. One would expect that the request will never fully be able to compete with engaging in the stereotypic behavior ad lib. It is therefore important that the dual contingency be operable. The following contingency box illustrates this requirement.

FUNCTIONAL TREATMENT: DA 1.2: TANGIBLE REINFORCER

Plan for Target Behavior If the client shows signs of attempting to jump out of the wheelchair, he will be physically prevented for a period of 5 minutes subsequently.

Contingency Plan for Replacement Behavior With some initial prompting, the client is taught how to wheel his chair over to the platform and engage in a series of physical movements that result in his propping himself onto the platform, and then gradually traversing down the platform safely.

Here is another example of this treatment option. Suppose a client frequently runs out of a female residential facility and lacks safety skills involving roads and cars. She leaves the facility simply to get outside. Such is not an unreasonable behavior because one can stay inside only for so long before wanting to have a change in scenery. However, her unauthorized and spontaneous leaving the facility without staff supervision is a definite serious problem, given her inability to navigate roads and cars safely.

Suppose the client is taught to request an outside activity (with staff supervision) by signing “walk.” When she wants to go outside, she would be prompted to sign “walk.” The staff would then take her hand and let her guide them to the area she wished to go to. This allows her to get outside the house, but with the necessary staff supervision.

The following are some additional illustrations of the mand option with prior clinical examples:

I Need a Change of Clothing. A male client rips off his clothes occasionally because he doesn’t like the clothes he has on. Rather, he prefers other clothes. You can see that reinforcing a request for new clothes, or allowing him to choose which clothes to wear in the morning for work or school, is more preferable from a management perspective than the current “clothes ripping” behavior.

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FUNCTIONAL TREATMENT: DA 1.2: TANGIBLE REINFORCER

Contingency Plan for Target Behavior (chain interruption) If the client engages in the target behavior (runs outside), she will be brought back immediately and required to wait a period of time, for example, 1 to 2 minutes, before being prompted to perform requesting behavior. If she is caught running before getting outside, the same contingency is in effect.

Contingency Plan for Replacement Behavior If she signs “walk,” she will be allowed to go outside if she walks appropriately with staff. Staff should prompt such behaviors initially to replace running outside, as well as massed trials of practice (if replacement behavior diagnosis is inept repertoire; see Inept Repertoire Category section of this chapter).

FUNCTIONAL TREATMENT: DA 1.2: TANGIBLE REINFORCER

Contingency Plan for Target Behavior (chain interruption) If the client begins to engage in the initial forms of the target behavior (tearing at clothes), he or she will be physically stopped (immediately) and required to wait a period of time, for example, 1 to 2 minutes, before being allowed to engage in an alternate behavior.

Contingency Plan for Replacement Behavior If the student signs “new clothes,” he or she will be allowed to procure a choice of clothes to wear. The student may need staff to prompt such a request immediately when forced to wear undesired clothes, as well as massed trials of practice (if replacement behavior diagnosis is inept repertoire; see Inept Repertoire Category section of this chapter).

One should realize that developing these specific communicative behaviors will be functional only if the DA 1.2: Tangible Reinforcer diagnosis was accurate. Suppose clothes ripping is maintained because the client likes the “feel” of ripping clothes? Would teaching the client to request a change of clothes decrease the clothes-ripping behavior? Probably not! In fact, this program might provide “more fuel to the fire!”

Privacy Please. A male client with mental retardation engages in masturbation out in a public, open area of a residential facility. Perhaps such behavior should be done behind closed doors! Teaching him to request privacy via a signal allows staff to mediate this request in the following manner. He is brought to his bedroom area where the door is closed. He is then free to engage in such behavior. Of course, he is not allowed to engage in public displays any more, and such attempts are immediately stopped by removal of the opportunity for a designated time. As the staff become excellent at thwarting his public attempts, requesting privacy becomes more attractive and functional. Exhibiting such a request provides unhindered access to genital stimulation. His behavior changes as a function of differential reinforcement. Public displays undergo extinction, while requests for privacy increase. Everyone is happy!

Delay of Gratification Training Option (Omission Training) Allowing a client free unrestricted access to the desired reinforcer, contingent upon a request, is certainly a good first strategy to use in many cases. Developing a mand for accessing a reinforcer is certainly more preferable than denying access to the reinforcer with concomitant side effect behaviors. Case in point: Obstructing the client’s access to the bathroom in the prior real-life example resulted in generating other more disastrous behaviors, while not solving the initial problem.

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Therefore, teaching the client to mand (request) for a desired reinforcer should have the effect of removing problem behaviors whose function was to access the prohibited reinforcer. Unfortunately, in some circumstances, such a strategy as the replacement function option may run into trouble. Let us take a young girl in an educational program who frequently engages in stereotypic behavior of touching the floor five times each side with her left and then right hand. The teacher decides to develop a requesting option that allows her to sign “play.” Contingent upon signing “play” she is allowed to touch the floor in an area of the classroom designated for such behavior (to develop setting stimulus control).

Such a plan may not reduce the frequency of stereotypic behavior to a more acceptable level. Suppose the client requests permission to engage in stereotypic behavior every 2 minutes? She is requesting it so often it is to the point where the teacher cannot get her to complete any instructional task! What do you do then? Obviously, a client who frequently requests to engage in stereotypic behavior would pose a problem for most school or work environments. In many cases, developing requesting behaviors to access sensory or tangible reinforcement should also be combined with other replacement function options. Such an additional strategy should gradually reduce the level of accessing the reinforcer to a more manageable reasonable level. I have termed it, “weaning them off of frequent reinforcement.”

DISCUSSION QUESTION 4B Do you think most people expect a skill, such as the ability to delay immediate gratification, to develop naturally, without structured efforts on the part of care providers? Why is that a presumption?

One treatment option of choice for these circumstances is omission training (DRO) or what we term, delay of gratification training. In delay of gratification training, the client is taught to forgo engaging in the target behavior that is producing reinforcement for a designated amount of time. Fulfilling this requirement is the contingency for authorized access to the sensory or tangible reinforcer (Mazaleski, Iwata, Vollmer, Zarcone, & Smith, 1993). By beginning with a small amount of time, termed the DRO interval, the client learns to reliably delay gratification. Contingent upon success being obtained with the initial small DRO interval, the interval is gradually increased. Therefore, the client learns to forego the reinforcer for longer periods of time in a progressive manner. This develops greater self- control in regard to the client’s baseline level of access, in contrast to where she previously required more immediate gratification. Additionally, a chain interruption procedure is deployed contingent upon the behavior, with a restarting of the full DRO interval.

This replacement function option does not develop a specific replacement behavior, or even a systematic chain of behaviors. Hence, it is often not considered by many as a viable treatment option. However, it can be very fruitful in progressively increasing the length of time a client goes without “needing” access to the reinforcing event. The performance criterion for accessing the desired activity or item is the absence of the target behavior (which is not a behavior), or the occurrence of any other behavior(s).

However, such a strategy allows a behavior analyst to dissuade someone of their frequent access of a desired event. It accomplishes this goal by gradually increasing the DRO1 interval, which develops the ability of the individual to wait for longer periods of time before accessing the desired event. In the common parlance, such a phenomenon is called the “ability to delay gratification” (hence our use of the term, Delay of Gratification Training).

Talking Is Good When It Occurs in the Right Context! Remember the client with dis abilities who talked loudly to herself while pushing a laundry cart across a parking lot (see Chapter 3)? This behavior was hypothesized by me to produce its own auditory (hearing one’s voice) or kinesthetic stimulation (sensory effect on vocal cords). If a review of antecedent context data reveals that such vocal discourse occurs at a consistent rate during staff absence, what can be done to bring it under more acceptable conditions? When is vocal behavior acceptable? When you talk to other people! When is it OK to talk to oneself without raising suspicions that one is delusional? When it is done as a song!

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If vocal behavior produces its own reinforcer, what can compete with that? In some cases, I have used a microphone (Mr. Mike) that enhances the auditory production of voice. How would delay of gratification training work? The use of Mr. Mike to talk or sing can be earned when this client achieves the absence of talking-to-self behavior in the designated DRO interval. Of course, the client would need to be monitored for instances where he or she would engage in self-talk in public, with the following contingency rendered for such occurrences.

FUNCTIONAL TREATMENT: DA 1.2: SENSORY REINFORCER

Contingency Plan for Target Behavior (chain interruption with Reverse Premack) If the client engages in the target behavior (self-talk in public), he or she will be brought inside immediately and required to engage in a nonpreferred task. Subsequently, the client will be allowed to engage in prior activities with the DRO interval being reset.

Contingency Plan for Replacement Function If the student does not talk to him- or herself while in public for the entire DRO interval, the student is provided a designated amount of time on Mr. Mike as soon as possible after achieving success. Later in the program, it may be possible to provide points when he or she succeeds in a DRO interval and allow an exchange of points after meeting two or three DRO intervals.

Premack Contingency Option A common question that comes up when discussing the development of a durable and spontaneous requesting repertoire is, Do you have to give the reinforcer every time it is requested? The response is, Yes, in the initial phase of the program. In order to build a new behavior, all basic behavioral texts will indicate that a continuous schedule is a must! But this may create some problems, as delineated in the previously mentioned treatment option. Should parents, teachers, and staff provide a designated item or activity whenever a client requests it? If people do this, it will create demand machines. Children and clients will spend too much time requesting food and other reinforcers.

Although the answer to the first question is still “Yes,” the ramification of such a strategy does bring up a dilemma. For most of us, we have learned how to delay gratification for some period of time on many activities and events we find reinforcing. A client or child who constantly requests food and particular kinds of food items may be engaging in unhealthy behavior patterns, to say the least!

What can be done for such cases? How will the child learn to be reasonable in regard to access to reinforcing items and events? The answer lies in utilizing the Premack contingency. In simple terms, access to the desired sensory or tangible event is made contingent on performing a less preferred (or nonpreferred) activity. In this option, before a client can request a reinforcer and receive it, certain tasks have to be completed. In the case of school settings, the teacher would use this strategy in the following manner. The student would be required to complete certain academic or instructional tasks prior to requesting and receiving access to certain reinforcers.

The Premack contingency could be tagged on to the request (mand) replacement function option delineated previously. This strategy, like delay of gratification training, would also begin to develop the individual’s ability to delay gratification. The Premack contingency requires some low probability behavior (e.g., completion of a task or series of tasks) to occur prior to the client being allowed to request access to the desired sensory reinforcer. Hence, access to the reinforcer can be at designated times (after tasks are completed) and suitable settings (engaging in the behavior only in certain nonpublic or nontraining areas). The task completion criteria for accessing the positive reinforcer can be progressively altered as a function of the success of the program in producing the contingency.

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Table 4.6 illustrates how the Premack contingency option contrasts with the other replacement function options detailed previously. The target behavior is stereotypic hand flapping and is maintained by the direct sensory result it produces.

Similar to delay of gratification training, the Premack contingency option will eventually reduce the frequency of accessing the reinforcer. In contrast to delay of gratification training, the Premack contingency requires some performance on designated tasks as the conditional event for reinforcement of the requesting behavior. Again, chain interruption procedures are utilized should the client attempt to access the sensory or tangible reinforcer without prior authorization. Such unauthorized attempts also can be punished by increasing the number of tasks required contingent upon the attempt to access the reinforcer prematurely (see “Reverse Premack Principle” box).

REPLACEMENT FUNCTION OPTIONS FOR SMA PROBLEM BEHAVIORS There are five replacement function options when treating a problem behavior that is maintained by SMA to positive reinforcement. With all SMA problem behaviors, withdrawal of reinforcement (extinction) for the occurrence of the target behavior is a requisite for making the alternate behavior functional.

DA (to tangible reinforcer) replacement option: Developing or strengthening a chain of behaviors that produce the desired tangible reinforcer directly.

Access mand (request) replacement option: Identify a requesting behavior (mand) that would allow staff to mediate such a request or choice by providing the client with the desired person’s attention or tangible reinforcer.

Differential reinforcement of low rates (DRL) group contingencies for peer attention: Designating a lower rate of the target behavior (differential reinforcement of low-rate behavior), which is the criterion for providing a powerful reinforcer to the group. The target rate may be for either the individual client’s behavior or a group’s level of behavior or performance.

Delay of gratification training option: Identify a length of time that you want the individual not to perform the target behavior, that is, the nonoccurrence of target behavior for a set time period. Contingent upon the client not engaging in the target behavior in the DRO interval, access to the desired adult or staff attention or tangible reinforcer is provided.

Premack contingency replacement option: Identify a regimen of tasks that, when completed, allows the client to access the reinforcer (Premack Principle).

TABLE 4.6 n CONTRASTING REPLACEMENT FUNCTION OPTIONS FOR DA 1.1: IMMEDIATE SENSORY SIMULI

Requesting behavior option

Client signs, says, or points to picture icon requesting access to stereotypic behavior

Delay of gratification training

Client goes without engaging in stereotypic behavior for some period of time and then is allowed to make a request to engage in hand flapping in a designated area for a designated period of time (which will be honored)

Premack contingency

Client performs designated number of tasks and then is allowed to make a request to engage in hand flapping in a designated area for a designated period of time (which will be honored)

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Extinction With SMA problem behaviors, there is usually no need for a chain interruption strategy, unless the problem behavior can be dangerous to the client or others (e.g., self-abuse, aggression, property destruction). In those cases, simply for safety requirements, a chain interruption procedure delineated in the previous section should be used. With other SMA behavioral functions, there is no need to physically interrupt the behavior. Simply not providing the positive reinforcer contingent upon the problem behavior will be sufficient to facilitate its demise. In other words, extinction is necessary.

Extinction is defined as the removal of the functional reinforcer contingent upon the target behavior occurring. Given that problem behaviors in this category are maintained by the behavior of others, it becomes obvious how the reinforcer will have to be removed. People will have to behave differently when the target behavior occurs!

To implement extinction, one must be able to tolerate the occurrence of the target behavior (Iwata, 2006). Staff, parents, care providers, and teachers need to refrain from the delivery of the reinforcer for the problem behavior, whether it be adult attention or a tangible item or event. Peer reinforcement of the previously reinforced target behavior needs to be removed, but the mechanism for this SMA 2.2 function is somewhat different than with other socially mediated reinforcers.

All the functional behavioral treatment plans would require that the maintaining reinforcer for the target problem behavior be eliminated, or at least weakened (i.e., disabled). If complete elimination of the contingency is not plausible (humans will be humans), then there needs to be a significant disabling of the previous temporal and reliable relationship. The weakening of the relationship can be based on the contingency being less reliable than the one that should exist for the replacement function.

For example, let us say that the tantrum behavior of an adolescent in a group home results in getting the desired reinforcer within 5 minutes of the tantrum onset, 70% of the time. To disable this relationship, tantrum behavior should not produce the desired reinforcer at all. This designation would be specified in the behavioral plan. Once the plan is enacted, we can hope for a 0% relationship between tantrums and access to socially mediated reinforcers. However, in human service and educational settings, perfect performance is something to strive for, but not always the case. However, if the staff or teachers are able to remove the delivery of the reinforcer for 80% of the tantrums, they have significantly disabled the functional ability of tantrums to produce reinforcement. In addition, if doing a simple chore in 5 minutes results in 100% access to the reinforcer, the previous relationship between tantrums and reinforcement has been further weakened. Given that data, the most efficient behavior for accessing desired reinforcers is doing a designated 5-minute chore.

In summary, complete removal of the functional reinforcer for the target problem behavior is preferred. However, perfection is not always viable in practice. But if one can seriously weaken the existing maintaining contingency for problem behavior relative to the replacement function, change in client behavior should occur.

Here are some strategies to achieve this contrast. Making the replacement behavior easy to perform is an excellent strategy. Concurrently, making the target behavior less efficient at accessing the desired reinforcer enhances the “attractiveness” of the replacement function. It is also possible to add a punishing effect by instituting a Reverse Premack Principle.2 The Reverse Premack Principle would involve making the occurrence of the target behavior serve as a mand for a nonpreferred regimen of tasks. Such a punishment contingency can also be an adjunct complementing extinction.

DA to Tangible Reinforcer In some cases, if appropriate, the client can be taught to access directly the tangible reinforcer that was maintaining the problem behavior. Teaching a client to pour his or her own drink

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instead of throwing a tantrum (to have someone else get it) is obviously a great solution, once the function of tantrum behavior is discovered.

I Want a Sandwich, Please. A male adolescent with developmental disabilities would throw a tantrum and yell loudly when hungry, and staff on an intermittent basis would provide food to him contingently (LaVigna, Willis, & Donnelan, 1989). Teaching him to make his own sandwiches and snacks negated the need for tantrums when he was hungry. Note that the behavioral effects of the tantrums and the sandwich-making behavior are the same, but one alternate is obviously more desirable than the other.

FUNCTIONAL TREATMENT: SMA 2.3: TANGIBLE REINFORCER, FOOD ITEM

Contingency Plan for Target Behavior If the client throws a tantrum and yells loudly, the client will not receive food.

Contingency Plan for Replacement Behavior If the student makes his or her own sandwich, the student can proceed to eat it.

REVERSE PREMACK PRINCIPLE

Assignment: Reverse Premack Another method of disabling the function of the target behavior is to have such a behavior serve as a mand for a regimen of nonpreferred tasks. In other words, the occurrence of a higher probability behavior (target behavior) is followed by the client engaging in a behavior of lower probability, thus setting up a punishment contingency (Premack, https://en.wikipedia.org/wiki/Premack%27s_principle).

After reviewing the narrated PowerPoint lecture entitled, “Reverse Premack,” write a paper that delineates the following in order:

1. Explain the premise of the contingency, and how it differs from the traditional use of the Premack Contingency.

2. Identify what effect the Reverse Premack has on the behavior that produces the contingency. Is the Reverse Premack used to increase or decrease a behavior?

3. Delineate how such a contingency would be used for a DA function, (e.g., pica: putting inedible items in one’s mouth). Explain what would happen when the pica incident occurs by depicting a hypothetical client with such behavior. Make sure you indicate how you selected the particular socially mediated contingency of pica in terms of its relative probability to the pica behavior.

4. “Using an AB design, generate hypothetical data for a client who mouths inedible objects and create a table or graph that displays data from six 1-hour sessions for a baseline (control) condition. The B condition should then be an equal number of sessions with a Reverse Premack condition in effect. Then explain what the results of your graphed hypothetical data indicate; that is, what is the efficacy of the Reverse Premack contingency compared to the control condition.

Access Mand (Request) Option In this treatment option, the desired reinforcer, whether it be adult attention or access to a tangible reinforcer, is provided by staff upon an appropriate request. Concurrently, the

Using Reverse Premack Narrated PowerPoint Presentation

www.springerpub.com/fbadt

4 Function-Derived Treatment Options 155

previous access function of the target behavior is negated through extinction. As an example, let us look at how this differential reinforcement process would work for a young girl with autism who falls on the floor. The functional behavioral assessment (FBA) data point to the maintaining contingency as access to tangible reinforcer (SMA 2.3: Tangible Reinforcer). Currently falling on the floor is followed by teacher attention in the form of cajoling her to get up, rubbing her shoulders as an incentive to get up. All these teacher behaviors have nothing to do with the function of the tantrum behavior. Finally, the teacher gets her favorite picture book out and shows her the pictures while coaxing her to sit at the table (Bingo! there is the function!). It should now be evident that to make tantrum behavior nonfunctional, the book should not be rendered during an episode. Hence, the plan calls for a nonvocal request (i.e., raise hand) to serve as the behavior that will bring the teacher or aide over to her with the book and begin showing her the pictures. This replacement behavior, that is, raising her hand, would now substitute for dropping on the floor as a means to get attention. Such a request will now result in an adult interacting with her while looking at the book. If access to the book is the maintaining contingency for the student’s target behavior, then reinforcing requests at 100% levels negates the function of the target behavior.

Let us examine how such a replacement behavior ameliorates the prior function of the target behavior. Previously, book reading was delivered when this child dropped to the floor. Now such behavior results only in a postponement of this activity. The extinction plan might be designed so that the exhibition of the tantrum behaviors results in a time period where access to the book is withheld. The request for the book would be reinforced only after this extinction period. However, if hand raising occurs prior to the target behavior, it immediately produces this event. To reiterate, disable one function, enable another!

FUNCTIONAL TREATMENT: SMA 2.3: TANGIBLE REINFORCER, BOOK-READING ACTIVITY

Contingency Plan for Target Behavior If the young girl drops to the floor, she will not receive the book-reading activity for 5 minutes after getting up and sitting back down in her seat.

Contingency Plan for Replacement Behavior If the young girl raises her hand, she will immediately receive the desired activity for a 3-minute period (unless first contingency is in place). Such behavior may need to be prompted in the beginning, particularly if replacement behavior diagnosis is inept repertoire (see Inept Repertoire Category section of this chapter).

Realize that requesting will be functional only if you are correct in your analysis. If this child’s dropping to the floor is the result of getting a book, making it more profitable for her to request the book than drop to the floor will prove effective. If this is not the actual function, that is, the reinforcer maintaining the dropping behavior is not the book-reading activity, this plan will be ineffective. Why? A misdiagnosis of function means that the primary purpose of dropping to the floor was not to get the book-reading activity, but rather something else. A wrong hypothesis about the behavior’s function leads to selecting a wrong replacement function, which then leads to an ineffective treatment.

A Pinch Here, a Pinch There. How would this replacement option be used to treat the client’s pinching behavior I observed in the previous chapter? Because pinching is currently maintained by the resulting staff interaction, this contingency needs to be rectified. Pinching should obviously result in no (or little) staff interaction. However, a sign for “communication desired” by this individual (e.g., signing “me”) would result in someone coming over and

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shaking his hand and talking with him for a while. Replacing access to social interaction from the target behavior to a request for interaction will switch the schedule of reinforcement in favor of the more appropriate behavior. It is quite plausible that the signing response will need to be shaped and prompted frequently before becoming more spontaneous.

FUNCTIONAL TREATMENT: SMA 2.1: ADULT ATTENTION

Contingency Plan for Target Behavior If the student pinches a staff member, he or she will not receive any attention for 5 minutes subsequently.

Contingency Plan for Replacement Behavior If the student signs “me,” he or she will immediately receive the desired social interaction activity for a 3-minute period. Such behavior may need to be prompted in the beginning, particularly if such a sign is not currently in the person’s repertoire.

SIMULATION EXERCISE: THE “YES” GAME

This exercise can be used to simulate how an alternate response (e.g., a mand or request) is differentially reinforced in functional treatment. It is a great exercise in illus- trating how both reinforcement and extinction are juxtaposed when developing an alternate behavior while diminishing other behaviors.

Select a behavior that represents the desired target skill, but do not disclose this to the role respondent (a student who volunteers for class simulation is sent outside the classroom). When the volunteer leaves the classroom, the remainder of the class is informed what the behavior is so they can observe how differential reinforcement is applied. The volunteer is then asked back inside the classroom and to engage in any behavior (that is suitable for public display). The volunteer is told that “yes” (or you can use applause) means he or she is on the right track and its absence indicates he or she is not. You say “yes” when an approximation of the target behavior occurs, and say nothing when the exhibited behavior does not meet the criterion of reinforcement at that time. Once the target behavior occurs (hopefully), switch roles so that the student gets practice at being the therapist. Such a simulation illustrates the basics of differen- tial reinforcement by reinforcing approximations to the target request or mand, while learning to produce extinction for other forms of behaviors (i.e., undesirable behaviors that occur). Make sure that the volunteer just relies on “yes” versus its absence in get- ting the respondent to engage in the designated behavior.

A Request for Food to Replace Self-Injury. In the previous chapter, a hypothetical student with severe disabilities exhibits an unacceptable level of self-abusive behavior. Your observations revealed that the teacher was unwittingly developing the child’s self-abuse as a functional behavior when the student wanted food, by giving him food to “calm down.” Because this student is unable to vocally request food, how would one replace self-injury with requesting behavior? Simply teach the student how to sign (or use other nonvocal system) indicating a request for food at times when the student wants food. The staff would reinforce such behaviors with food while self-injury does not result in food, that is, undergoes extinction. Therefore, self-abuse becomes less probable under the motivational condition of desiring food, being weakened by its inability to access food, while signing becomes stronger.

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DRL Group Contingencies for Peer Attention Removing peer reinforcement for undesirable problem behaviors requires a different mechanism. One cannot often successfully instruct peers to ignore the problem behavior (i.e., remove peer attention) so the target student will behave more appropriately. What is in it for them? To remove peer reinforcement for problem behavior, it is necessary to contrive the following contingency: powerful contrived reinforcers for the group are made available if the child’s exhibition of target problem behavior meets a selected behavioral criterion. In many cases a group criterion level can be designated, for example, the class cannot go over five disruptive incidents in the morning in order for everyone in the class to earn 10 minutes of extra recess after lunch. Here are some examples.

Everyone Loves a Clown (Except the Teacher). Let us take the case of a hypothetical junior high school special education student, Billy. Billy engages in frequent, verbally inappropriate behavior toward teachers. Subsequent to such behavior the class laughs, girls smile, boys nod their heads, and all have a good time. He has peers wanting to hang out with him during recess and at lunch. Unfortunately, this is exacerbated even when Billy is disciplined by being sent to the principal’s office. How can one make his peers responsible for not feeding into this behavior?

FUNCTIONAL TREATMENT: SMA 2.3: TANGIBLE REINFORCER, FOOD ITEMS CONTINGENCY

Plan for Target Behavior If the student engages in self-injury, a chain interruption procedure will be used (to include restraint for a specified period of time), and the student will not receive any food item for 3 minutes subsequently. In addition, a Reverse Premack Principle would be instituted during the 3 minutes of nonaccess.

Contingency Plan for Replacement Behavior If the student signs “food,” the student will immediately receive the desired food item, in small quantity, with an opportunity to continue requesting to get more (until a designated amount has been consumed). Such behavior may need to be prompted in the beginning, particularly if the replacement behavior diagnosis is inept repertoire (see Inept Repertoire Category section of this chapter).

DISCUSSION QUESTION 4C When you were in junior high school, did everyone love a class clown? Were there some classes where such “clowning” behaviors were more prevalent? Why?

A group contingency involves the setting of a contingency in which the group attains (or not) a group reward, contingent upon the group behavior or performance. As an example, the following contingency can be enacted with extra peer conversation time at the end of the period as the reinforcer. If the class stays at or below a certain level of inappropriate comments (taking into account Billy’s rate), the whole class earns conversation time. If the class goes beyond the designated number of allowed inappropriate comments, they all lose out. Do you think that peer attention and approval for Billy’s inappropriate verbal behavior will still be forthcoming?

Do Not Argue! Simply asking Antonio and his sister to stop arguing, separating them, and/or intermittently sending them to their rooms did not work. There were great bouts

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of verbal abuse inflicted upon each other during these arguments. Antonio and his sister were foster children living in a two-parent household. Like many other parents, these foster parents (actually his grandmother and grandfather) attempted to figure out who started the argument and why. This strategy often led down the path of no return. Hence, the referral for my behavioral intervention services to address this problem behavior as well as others that were occurring at school.

Why do children argue? Arguing is usually maintained by the listener’s response. One cannot argue with a wall, but one can attempt to have the last word with another human being. Sometimes the arguments between Antonio and his sister were about silly things. Other times they were about who gets what TV show or favored item or activity. After collecting behavioral assessment data, my behavioral specialist (Ron Pekarek, BCBA) designed a plan to address this interlocking dynamic. It was obvious that we were going to discontinue attempting to find out who started it as a method of dealing with such interactions.

Therefore, rather than deal with the incident as a CSI forensic specialist, the designed intervention simply counted each argument against both children. An argument was counted when both children said something to each other in a negative or derogatory tone. With behaviors that are maintained by peers, it is essential to allocate consequences to all concerned. Individual contingencies for the one who started it, even if such could be ascertained, would probably be ineffective. To remove peer reinforcement, one has to make the levied contingency affect all those involved during the incident.

Ron taught the grandmother how to use early bedtime as a contingency for unacceptable levels of arguing on a given day. In the DRL contingency, if Antonio and his sister had two or fewer arguments in a given day, then they both go to bed at their normal 8 o’clock time period. However, three or more arguments resulted in earlier bedtime. The data on average frequency of arguments between Antonio and his sister follows. Table 4.7 shows what it did for Antonio.

Note that in the first 2-week period (3/8–3/17), the average daily rate of arguing was 1.5. This translates to the two children rarely having three arguments because you know what kicks in if that happens. Apparently these two children really liked staying up until 8:00 p.m. The effect on behavior becomes even more pronounced in the weeks to follow. The period from 4/21 to 5/14 did not have one incident of arguing behavior. There are not too many families that can boast that, especially those with children who were previously experiencing severe difficulty in dealing with each other without taunting and arguing.

It is important to note that arguing might still produce the desired listener response, yet the punishment contingency overrides this relationship. While the discriminative stimuli for verbal aggression were still present, a concurrent contingency involving removal of a reinforcer, contingent upon the verbal arguments, successfully competed with the behavior’s functionality.

DISCUSSION QUESTION 4D Describe how Ron Pekarek intervened with the brother and sister who argued and fought a lot. Why was it necessary to provide a uniform group contingency for arguing that affected both of them (and not find out who started the argument)?

TABLE 4.7 n AVERAGE FREQUENCY OF ARGUING ACROSS BASELINE AND CONSEQUENCE TIME PERIODS

Baseline 3/8–3/17 3/18–3/27 3/28–4/12 4/13–4/19 4/21–5/4 5/5–5/14

3.0 1.5 0.75 0.50 0.25 0 0

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Delay of Gratification Training Option (Omission Training) The use of the delay of gratification training option for SMA problem behaviors is similar to the previous application for DA behavior problems. If the client goes without engaging in the target problem behavior for a designated period of time, the delivery of the desired reinforcing event occurs. The occurrence of the target behavior results in the postponement of the reinforcer, in that the DRO interval is extended. For example, if a DRO interval is set at 4 minutes, the delivery of the reinforcer is contingent on the client not performing the target behavior for that period of time. The client can engage in a variety of other behaviors, but the functional reinforcer is conditional upon the absence of the target behavior during the 4-minute DRO interval. However, if the behavior does occur within the 4-minute period, the DRO interval is reset for the full time period contingent upon the occurrence. The following examples illustrate this dual contingency.

Waiting to Get New Clothes. Delay of gratification training can be added as a component to a requesting option for SMA problem behaviors. A previous example involved a client who would rip off his or her clothes to get staff to bring new clothes. How would delay of gratification training be used to decrease the clothes ripping behavior? Perhaps the behavior analyst might consider building in a certain amount of time to elapse without the target behavior occurring following a request for a change of clothing. Initially, the length of the DRO interval would be small to promote success in the beginning of the program. The DRO interval would be gradually increased once the client has learned to tolerate the nonpreferred clothes for some small period of time. Further, ripping off nonpreferred clothes during the DRO interval would result in a resetting of the DRO interval back to zero. Remember, extinction of the previously reinforced response has to occur. When the DRO interval elapses, the client would be allowed to request, in whatever manner, more preferred clothes. In this gradual progressive manner, the client is being taught how to delay gratification for longer periods of time.

FUNCTIONAL TREATMENT: SMA 2.3: TANGIBLE REINFORCER, FOOD ITEM

Contingency Plan for Target Behavior If the client rips off clothes, he or she will not be given preferred clothes. Further, the DRO interval is reset. If the client engages in a tantrum subsequent to not getting new clothes, the DRO interval is reset after the tantrum behavior has subsided.

Contingency Plan for Replacement Function If the student signs “shirt please,” a wait interval (DRO) is designated. Following the lapse of the designated DRO interval, the student will receive the desired clothing item. The DRO period should be short in the beginning (e.g., 2 minutes). It can be progressively lengthened with success.

Get to the Student Quicker. What about the student who bangs her desk to get the teacher to come over to her when she needs help (see I Want Your Attention, Now! in Chapter  3)? This scenario from the prior chapter found that the behavioral function of this target behavior was a quicker access to teacher help and attention. When this student wanted the teacher to come over to her, raising her hand was not as effective or efficient as banging on the desk. Banging on the desk produced faster results. Hence, that form of behavior was strengthened under the conditions of wanting teacher attention and the teacher being with other students.

Of course, waiting and raising one’s hand appropriately are alternate behaviors that are desirable. But as long as banging the desk produces attention more quickly, the alternate behaviors do not have a chance of competing with this behavior. Hence, a DRO would provide a consequence to the target behavior that further disables its ability to access the positive reinforcer. The rearranged contingencies should be as shown in the following box.

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How Long Should the DRO Interval Be? Unfortunately, in some cases, an interval length for the DRO is not determined by baseline data. Rather, the naive program designer may arbitrarily set the DRO interval at some value perceived as fair, such as 5 minutes. This arbitrary decision can often lead to program failure. The DRO interval should be set as a function of the baseline data. The baseline data collected should allow for the user to determine the average interval of nonoccurrence of the target behavior. This can be achieved simply by dividing the length of the data collection session by the frequency of target behavior. Table 4.8 provides this analysis for four sessions of data collection.

One can see that the average nonoccurrence interval ranged from a low of 3 minutes to a high of 10 minutes (best session). Therefore, selecting a DRO interval of 20 minutes would probably result in the student not earning the desired reinforcer very often (or not at all). Setting it at 1 minute would be comparatively easy. Setting it at 5 minutes would be reasonable. If this data was not available, an arbitrary selection might be 20 minutes or more. Setting it at 20 minutes would probably result in continued failure. Hence, the client rarely, if ever, earns reinforcement. The designer is then forced to go back to the target behavior to access reinforcement, or some other behavior that is equally unacceptable.

FUNCTIONAL TREATMENT: SMA 2.1: ADULT ATTENTION, TEACHER HELP

Contingency Plan for Target Behavior If the student bangs on desk, there is a delay in teacher attention for 3 more minutes with each incident.

Contingency Plan for Replacement Function If the student raises his or her hand (request for help) and waits up to 30 seconds, the teacher will come over and provide help. The wait period can be progressively extended with repeated success at prior wait periods (however, the DRO interval for the target behavior should also be proportionally lengthened).

DISCUSSION QUESTION 4E Let us say a parent has a 6-year-old child (nondisabled) who has severe tantrum behavior during shopping trips. The hypothesized access function is desired items (on the store shelves). Such tantrum behavior occurs subsequent to the child asking for the item, and being told, “No, you cannot have that, it is not on the list.” This child asks for several desired items during the trips. The usual outcome of a shopping trip is that three or more preferred items (that were not on the shopping list) end up in the shopping cart, often as a result of a screaming bout. What intervention strategy would be suitable for such an SMA function that does not entail honoring every request for some item? What would you recommend for the initial length of the shopping trip (and why)?

TABLE 4.8 n FOUR SESSIONS OF DATA

Date Frequency of Target Behavior

Duration of Data Session (in Minutes)

Average Nonoccurrence Interval Length (in Minutes)

11/1 5 50 10

11/1 8 48 6

11/2 10 50 5

11/3 10 30 3

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Premack Contingency Option In this option, the desired reinforcer is produced following the client’s successful compliance to a designated regimen of tasks or demands. In a school setting, getting free time would be contingent on performing a certain number of tasks. During free time, the student would be allowed to access desired events and activities.

School Placement (and Mom’s Job) in Jeopardy. In the early 1990s, a 10-year-old boy in a special education classroom (SDC) who engaged in extreme disruptive behavior and low rates of task engagement was referred to me. When he was younger, the school staff would put him in time-out, but as he became older and of significantly greater weight (over 110 pounds), they could no longer guide him to the time-out area. The solution to such a quandary was to send him outside to “cool off.” As one might imagine, he was spending quite a significant part of the day “cooling off.” When he refused to work subsequent to a reasonable “cooling off ” session, the school staff called his mother to take him home for the remainder of the day. His mother was being called several times a week to take him home. This “call mom” practice was having a deleterious effect on the mother’s employment situation, placing her current job in jeopardy. Additionally, the school was examining the possibility that he could not attend school if such behavior continued.

My behavioral specialist, Steve Taylor, noted that once he was outside he accessed a number of preferred activities, including playing with his matchbox cars. Such access to play activities contingent on disruptive and “agitated” behaviors produced an SMA function for those problem behaviors (SMA 2.3: Tangible Reinforcer). The proposed functional treatment would change how outside play with his toys would be obtained. Instead of disruptive behavior resulting in play, his completion of a few short instructional tasks would result in access to a specified amount of outside playtime. The use of this Premack contingency also required that disruptive and agitated behavior should no longer result in being sent outside. Fortunately, such behaviors seemed to decrease dramatically with the implementation of this Premack contingency. Further, during intervention, his willingness to come in from outside play and work again, to earn the opportunity for more time with his toys, seemed to be in stark contrast to the baseline.

The beneficial outcomes of this intervention involved the following. First, since the intervention ensued, mom was not contacted once to take him home early. Second, neither the student study team (SST) nor the principal any longer received referrals for the student’s problem behavior in the SDC. Third, compliance to tasks was optimal, with the amount of work required being progressively increased and reaching levels that were deemed nonproblematic. At 6-month follow-up, problem behaviors remained at very low levels.

Potato Chips: Bet You Can’t Have Just One. As you will recall, the hypothetical female client with schizophrenia in a day treatment program engages in property destruction to get another bag of potato chips. Such behavior is functional in that subsequent to the programmed time-out for this behavior, she is sometimes given another bag of chips. Although such behavior does not result in a second bag of chips every time, it is more successful in getting “seconds” than simply asking staff. Obviously, engaging in property-destructive behaviors needs to be seriously weakened in her ability to get potato chips. However, simply programming extinction for such behaviors may make the client engage in other more inappropriate behaviors that access this reinforcer. If left to chance, behaviors that may naturally develop may be as bad (or worse) than property destruction, such as self-abuse and aggression to others. Selecting an acceptable replacement function and training the staff to reinforce this behavior with extra chips is essential.

This case poses a significant problem. Her desire for more potato chips is after she has already had a bag. One could just reinforce her request for an additional bag of chips. However, such a contingency may lead to increased unacceptable levels of eating potato chips. She may satiate at six bags per mealtime! Simply reinforcing requesting behavior is often not a practical plan with food items.

However, requiring her to perform certain tasks to get another quarter bag of chips may prove useful. She would be required to complete three small tasks and then be allowed to request chips. What if she wants more? She would be required to perform another six tasks before being allowed to ask for chips and receive such. In these types of plans, increasing the performance requirement with each delivery makes the client want the chips less and less.

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FUNCTIONAL TREATMENT: SMA 2.3: TANGIBLE REINFORCER, FOOD ITEM

Contingency Plan for Target Behavior If the client engages in property-destructive behavior, she will not be given more potato chips following the planned time-out. Rather, following the time-out, she is given the opportunity to perform a set of tasks designated below to receive more chips. Also, a chain interruption procedure should be in place for property- destructive behavior, followed by removal from the area to a time-out.

Contingency Plan for Replacement Behavior If the student requests more chips, she can complete/comply with three task demands, and then she will earn a quarter bag of chips. She can repeat this until one additional bag is consumed. The number of tasks required to earn chips can be progressively increased by three tasks with each new request.

Why Does the Premack Contingency Work With SMA Diagnoses? The Premack Principle designates a relationship between a high-probability behavior (i.e., engaging in desired event) and a low-probability behavior (i.e., complying with certain task demands). But what is the point of the arbitrary selection of performing a set number of tasks as the replacement function?

It is often the case that the social environment has made it too easy for some children or clients to get certain events or reinforcers. Therefore, “ad-lib” access of such events occurs at unreasonable levels. To want someone’s attention is not a sin, but it surely is tough to accommodate when it is demanded every few minutes. Although this may be an acceptable state of affairs for infants, as children get older they have to be weaned off of such frequent and lengthy attention from their parent. Unfortunately, some children do not undergo such conditioning and learn to engage in disruptive and disastrous behaviors to continually access attention or preferred items or activities.

To reduce the client’s constant desire for a given reinforcer, a Premack contingency is well suited. Requiring the performance of a less preferred event as a condition for access to reinforcement is a strategy that will eventually wean them off of frequent access. I have viewed the success of several clinical applications of the Premack contingency in dramatically reducing the problem behavior (by hampering its function). A nice side benefit of this treatment option is that the “desire” for such an activity or event becomes lessened compared to when ad-lib access existed. If the client has to perform a series of tasks to get something, she becomes “happy” with getting a lesser amount of that something over a period of time.

Table 4.9 contrasts four replacement function options for self-injurious behavior involving an SMA 2.3 function: Tangible Reinforcer of food.

TABLE 4.9 n CONTRASTING REPLACEMENT FUNCTION OPTIONS FOR AN SMA 2.3 DIAGNOSIS

Requesting behavior option Client signs/says/points to picture icon requesting food

Alternate form reinforcement Client gets food item and prepares it to eat

Delay of gratification training Client goes without engaging in self-injury for some period of time and then is allowed to request food

Premack contingency Client performs designated number of tasks and then is allowed to access food item (possibly after a request has also occurred)

SMA, socially mediated access.

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REPLACEMENT FUNCTION OPTIONS FOR DE PROBLEM BEHAVIORS There are four replacement function options when treating a problem behavior serving a DE function. All the options below require a chain interruption procedure (delineated in a prior section of this chapter) for the target problem behavior. Chain interruption would involve stopping the child or client from directly escaping the aversive condition or stimulus. If chain interruption is not used, it is less likely that a designated alternate escape behavior will be able to compete with the problem behavior’s ability to effectively and efficiently terminate the aversive event. Of course, the selection of which option is best suited for a particular circumstance is a clinical decision.

Alternate DE form replacement option: Identify an alternate acceptable behavior that also produces escape from the aversive situation. Such a behavior should not be inappropriate or dangerous but does directly and immediately produce escape from the aversive condition in a more socially desirable manner.

Escape mand replacement option: The protesting or negotiating response is mediated by teacher, staff, or others by their removing or postponing the aversive condition from the client or removing the client from the aversive condition.

Tolerance training replacement option (i.e., differential negative reinforcement of other behavior [DNRO]): Identify a length of time that you want the individual not to perform the target behavior, that is, he “tolerates” the aversive condition for a designated period of time. The nonoccurrence of the target behavior for the DNRO interval period provides for the child or client to escape or avoid the aversive event (either by request or by direction of staff).

Premack contingency replacement option: Identify a regimen of tasks that, when completed, allows the client to escape the aversive condition or situation (Premack Principle utilized in an escape fashion).

Alternate DE Form In some cases, a more acceptable alternate form of escape behavior can be identified and developed. Such a behavior must be just as capable of producing escape from the aversive situation as the target problem behavior. This is the same principle that was used for DA problems except that the alternate form now produces DE. Many problem behaviors with young children may fall into this category. For example, spitting food out is unacceptable, yet everyone occasionally has food in the mouth that they find extremely distasteful. There are acceptable and unacceptable ways to remove food from the mouth. The acceptable behavior is for the child to use a napkin or go to the bathroom and spit out the food (see Table 4.10).

Night Waking Problems. Some children have problems with nighttime sleeping by themselves in a dark room. They often wake up and go into their parents’ bed. This pattern then becomes another problem, especially when it occurs frequently. The behavior of getting into the parents’ bed is directly reinforced by the termination of an aversive event (i.e., being alone in the bed at night when it is dark). If the aversive event is being in the dark at night,

TABLE 4.10 n REPLACEMENT BEHAVIOR—MORE ACCEPTABLE FORM

Reinforcer Undesired Form Desired Form

Removing unpleasant taste in mouth

Spits out food (wherever) Spits out food into napkin/ hand, throws in wastebasket

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perhaps some alternate behavior that eliminates that condition might be feasible. Teaching the child to turn on the light whenever he or she wakes up would be a desirable alternative. If darkness is the only aversive event, turning on the light would remove the aversive event without getting into the parents’ bed. However, if getting into the parents’ bed is also a function of some positive reinforcers, other contingency arrangements would be needed.

Nude Clients. This treatment option can apply to clients who frequently engage in ripping or tearing off their clothes. If such behavior is maintained by the direct removal of nonpreferred clothing, simply allowing them to change clothes or select their own clothing would do the trick! Of course, if such a behavior is maintained by social attention, this strategy would be ineffective in reducing the rate of clothes ripping. However, if the clothes the client is currently wearing are less desired, or the client is used to some other fabric (e.g., cotton, silk), this DE alternative form is well suited.

If the client is not capable of self-dressing, then this behavior may have to be taught (i.e., prompted and shaped) in order for it to be a useful replacement behavior. Other clients may not have previously changed clothes spontaneously because such behavior was (or would be) thwarted or punished by staff. Increasing their independent changing of clothes may require just a simple differential reinforcement plan—let them do it in a private area.

FUNCTIONAL TREATMENT: DE 3.1: NONPREFERRED CLOTHES

Contingency Plan for Target Behavior If the student engages in clothes-ripping or tearing behavior, a chain interruption procedure will be used. The client will then be required to perform three nonpreferred tasks under staff supervision (Reverse Premack).

Contingency Plan for Replacement Behavior If the student chooses his or her own clothes from a sample of acceptable clothing, he or she will be allowed to wear them. If the student changes clothes without engaging in any problem behavior, he or she will be allowed to wear those clothes. The student can change no more than three times in a given time period each day.

Escape Mand The client’s ability to terminate or avoid an undesired social or instructional condition can also be enhanced by developing two types of communicative skills: verbal protests and negotiating skills. Saying in a calm voice “I prefer not to do that” instead of screaming to avoid an aversive task is certainly more preferable from the standpoint of the caregiver or staff. However, if the client is incapable of appropriate protesting behavior, unfortunately, undesirable forms of protest fill the void under conditions where escape behavior is likely.

In some cases, protesting skills are not viable. For example, when the client or student is required to complete some assigned task that is essential for the client’s well-being, protesting the task probably should not lead to termination of the request. However, negotiation skills may be appropriate for this circumstance and should be developed. Negotiating for a smaller amount of an assigned task or for a shorter period of time to engage in the activity can often be successful and produce escape earlier than if negotiation had not been undertaken. Some examples might help illustrate this replacement behavior option.

How About Only Five Pages, Please? Suppose an FBA reveals that a student engages in a variety of “procrastination” behaviors (goes to bathroom, lies down, watches TV) when the

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homework assignment is relatively lengthy. Simply allowing the student to protest doing any homework would not be feasible. However, reducing the number of pages to read before a short break would seem to be more reasonable. Perhaps the student can be taught to negotiate with the parent the number of pages that must be read before taking a break. If the student commits to following through, the parent agrees to allow a short break following completion of the agreed upon task.

FUNCTIONAL TREATMENT: DE 3.1: SCHOOL HOMEWORK ASSIGNMENTS

Contingency Plan for Target Behavior If the student engages in direct avoidance of doing homework at the scheduled time, a chain interruption procedure will be used that involves terminating any event the client is currently engaged in immediately, other than sitting at the table with books out.

Contingency Plan for Replacement Behavior If the student, while at the table, negotiates a certain amount of the homework assignment to be done prior to taking a break, the parent authorizes such a plan and provides a break if the agreement is upheld.

In developing appropriate forms of negotiation, the verbal form should contain elements of a request instead of a refusal. For example, “How about if I—,” is an appropriate form of verbal behavior. In contrast, “I won’t do this!” is likely to result in lack of results from the staff person, teacher, or parent. Certainly negotiating the time or amount of a task is a much better alternative to the previous manner of dealing with the situation, that is, doing all kinds of things to avoid sitting at the table and studying.

Can I Do My Household Task at 4 p.m.? With regard to household tasks that people find unpleasant, negotiating the time at which they will be completed may be the solution for some clients. With some clients, staff have to constantly remind them to complete their chores. Such reminders and prompts often end in arguing, yelling, and sometimes worse, behavioral problems on the part of the client. Negotiating with the client a time in which a task will be completed allows the individual to postpone the aversive event until a time when other more preferred activities are not interrupted. This strategy would not be useful for some clients who detest ever doing the task or chore. The selection of a replacement behavior for them would require a different option, such as the Premack contingency.

FUNCTIONAL TREATMENT: DE 3.2: LENGTHY CHORE

Contingency Plan for Target Behavior If the client engages in direct avoidance of doing a chore, without negotiating an agreed upon time, a chain interruption procedure will be used. This procedure involves immediately terminating whatever the client is currently engaged in and requiring him or her to perform the chore immediately. Further, the ability to negotiate the time the task is to be done the next day is removed as a consequence, and the task will be initiated immediately after school.

Contingency Plan for Replacement Behavior If the client negotiates a certain time when he or she will initiate and complete the assigned chore, the parent authorizes such a plan and does not constantly remind the client, providing the contract is upheld (i.e., chore is completed by agreed upon time).

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Tolerance Training Option3

The previous two options involve a replacement behavior that allows the child or client to escape or certainly ameliorate an aversive condition. However, in many circumstances, one may not simply opt out of a social or instructional situation. For example, if an elementary grade student did not want to do go to large assemblies, it is unacceptable to simply opt out. However, keeping him or her there for over 15 minutes results in frequent disruptive behavior until he or she is removed for being too disruptive. Therefore, a more reasonable option may be to allow the child to leave the assembly when going without the target behavior for a reasonably shorter period of time. The child would have to tolerate the assembly for a designated period of time before being allowed to opt out. For example, if the child stays in the assembly for at least 10 minutes without engaging in the target behaviors, he or she could then leave.

In tolerance training, you identify a length of time for the nonoccurrence of behavior (a DNRO interval). When this criterion is met, you terminate the child or client’s involvement in the social or instructional situation. In this manner, you are developing an individual’s tolerance for a nonpreferred event. With success at lower DNRO intervals, you can progressively increase the DNRO interval required to escape, thus increasing the individual’s tolerance of aversive events of some duration.

I Need a Break. Remember the student with severe disabilities who lays her head on the table when asked to complete lengthy tasks? The use of tolerance training could provide such a reinforcer contingent on not doing such a behavior for a designated period of time. Let us say that the teacher has collected baseline data. The average length of time this child would go before putting her head on the table was 7 minutes (range of 3–10 minutes). With this baseline data, one can be guided to select a reasonable initial standard for reinforcement. The program designed thereby sets the DNRO interval at 6 minutes. If she does not lay her head down on the table for 6 minutes, she earns the right to do so for a 6-minute period and take a break. If she engages in the behavior prior to the timer elapsing, a chain interruption strategy is used. The teacher will immediately prompt her to pick her head back up. Additionally, the teacher will reset the DNRO interval length. Of course, with success, the DNRO interval could be progressively increased.

DISCUSSION QUESTION 4F How important is it to be able to tolerate aversive events as one gets older? Why is it some people seem to be able to “handle” aversive and unpleasant events (e.g., breaking up of a love relationship) while other people “fall to pieces,” sometimes to the point of being hospitalized for behaving in a manner that is dangerous to themselves?

Premack Principle (Escape) Again, the Premack contingency can be utilized, but under this option the completion of a designated number of tasks results in escape and avoidance of further tasks for some period of time. Where can a Premack contingency be useful? Some adult clients with disabilities are either at an employment setting or working in a site that is getting them ready for employment. In some of these cases, the actual task or job is not the problem. Rather, it is the fact that the client may not be used to working for lengthy periods of time without a break. Clients’ inability to work for a designated period of time produces an uncomfortable (aversive) situation for them. Hence, they engage in behaviors that are aimed at getting away from the tasks, that is, escape behaviors. If such behaviors occur often enough or are of a severe or dangerous nature, their placement is jeopardized.

The Premack contingency would progressively build these clients’ stamina for working continuously, possibly in a noncompetitive site beforehand. Initially, the break may need

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to come sooner (i.e., shorter number of tasks required to complete) than the criterion level (e.g., 2 hours). Setting up a Premack contingency would be effective in eventually reducing the number of behavior problems that previously terminated the work task directly, such as leaving the area.

A note of caution on the use of the Premack Principle for escape-motivated problem behaviors: Rearrangement of contingencies may not be the sole solution to problems that occur during certain academic tasks. In many cases, children are very inept at performing the assigned tasks. Simply arranging a contingency is not the answer. They will continue to find such tasks aversive as long as their competence in completing such tasks is lacking. It is not the purpose of this manual to go into great detail on instructional procedures; however, do realize that good teaching procedures are usually at the heart of problems that occur with instructional tasks that are relatively difficult for the child.

Psychotic Student? A junior high school–aged male student in a residential and day treatment program for severe emotionally disturbed children engaged in a number of disruptive behaviors (termed psychotic by some staff). During baseline, his work production on assignments was extremely low. Off-task behavior as well as out-of-seat occurrences (producing DE of assignment) were ignored; this student frequently was allowed to avoid completing any work. An FBA pointed to such behaviors as effective in escape and avoidance of his engagement of academic tasks.

The rearranged contingencies I set up were the following. In order to leave his seat and engage in free time activities, this student was required to complete a minimal amount of math work in one period, a minimal amount of reading in another period, and a minimal amount of writing in another period. Failure to do so resulted in his inability to get out of his seat to go “play.” He had been assigned a staff person prior to my involvement. This person ensured that he completed his assigned task prior to being allowed to get out of his seat. Failure to complete any assigned work at school resulted in the work being sent home and being finished prior to any TV time (this contingency was invoked several times). With success, the amount of material was increased progressively in all three periods until he was performing adequately by the end of the year.

I Need a Break. A Premack contingency can also be used with the hypothetical student who lays her head on the table. The contingency for laying her head on the table would still involve chain interruption. In addition to being required to pick her head up, she would also have to begin the designated number of tasks all over again. For example, let us say she is required to perform five tasks to earn a break (number of tasks determined with baseline data). If she completes five tasks in a row without putting her head down, she would be authorized to take a 6-minute break where she could put her head down. But the contingency for engaging in the target behavior requires a “re-set” of the task completion requirement. For example, let us say she puts her head down after just completing three tasks. Obviously, she would be interrupted at that point, but she would also have an additional five tasks to complete in order to get a break (Reverse Premack Principle). Putting her head down on the table unauthorized is quickly interrupted and leads to a further postponement of break time. (Such a strategy should receive written consent for school settings, and be within regulations affecting student behavioral plans.)

Note that with this dual contingency, completing five tasks “right off the bat” is far more efficient in getting an authorized substantial break than simply taking it unauthorized. The contingencies are stacked in favor of completing one’s work without taking an unauthorized break. Taking a break leads only to a postponement of the substantial break period. With success, the number of tasks required for a break could be progressively increased.

There are several considerations when utilizing the Premack option for escape-motivated behaviors. Once the student has finished the assigned tasks, he or she gets free time (access to preferred activities) for a designated period of time. It is unacceptable for the teacher or staff to provide additional tasks in this break period. Second, one needs to make certain that the student is capable of performing the assigned tasks. Third, start with a small number of tasks initially to ensure you don’t burn out the student before he or she is able to finish those tasks.

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REPLACEMENT FUNCTION OPTIONS FOR SME PROBLEM BEHAVIORS There are four replacement function options when treating a problem behavior that is maintained by SME of negative reinforcement. Extinction of the target problem behavior is essential. Extinction of escape maintained behavior requires a different repertoire from parents, staff, or teachers. Ignoring the behavior is not what is required for such a function. Rather, continuance of the aversive condition is required. It is essential that the termination or withdrawal of the aversive event not occur as a result of the target behavior occurring. If the schedule of negative reinforcement of the target behavior is not weakened, the replacement behavior will probably not be able to compete with the target behavior’s effectiveness in producing escape/avoidance under aversive EOs.

Alternate DE form replacement option: Identify an alternate acceptable behavior that also produces escape from the aversive situation. Such a behavior should not be inappropriate or dangerous but does directly and immediately produce escape from the aversive condition in a more socially desirable manner.

Escape mand replacement option: A designated appropriate protesting or negotiating response is mediated by teacher, staff, or others by their removing or postponing the aversive condition from the client or removing the client or child from the aversive condition.

Tolerance training replacement option (i.e., DNRO): Identify a length of time that you want the individual not to perform the behavior. The nonoccurrence of the target behavior for a set time period provides escape or avoidance of the aversive event (either by request or by direction of staff).

Premack contingency replacement option: Identify a regimen of tasks that, when completed, allows the client to escape the aversive condition or situation (Premack Principle utilized in an escape fashion).

Extinction Burst for SME Problem Behaviors How resistant to extinction will a given target problem behavior be? In applied settings, an inherent requirement of the professional behavior analyst is to consider the possibility that the target problem behavior may occur in bursts when an extinction condition is imposed. Problem behavior under intermittent schedules of escape that serves an SME function can pose a tremendous problem for implementation of a treatment plan requiring an extinction condition.

The durability of a target behavior in the absence of reinforcement can be assessed using a trigger analysis for escape maintained behavior (Rolider, 2003). This assessment method should be conducted only with written informed consent from the client or guardian. Additionally there should be an imperative for conducting such based on safety and/or training considerations. The same caveats apply to dangerous behavior, and use of precursors to end the session should be deployed.

In this variation of the trigger analysis assessment method (review this section in Chapter2 for details), the therapist presents the aversive condition for a period of time in a brief session. Unlike the prior procedure where the trial was ended contingent upon the target behavior, this variation continues for a period of time after the target behavior. Depending on the circumstance and the target behavior involved, a professional may need to apriori institute a behavioral criterion for ending the session by providing for escape (e.g., session ends if form of target behavior becomes more dangerous to self or others).

In some cases, it might be necessary for the staff person who has stimulus control over the behavior to be involved in the session, especially if the problem behavior has not generalized to different people. During the session, the aversive condition is maintained while the rate and duration of the problem behavior is recorded. For example, if a client

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hits him- or herself when asked to put his or her clothes in the hamper, the session would be conducted by providing this request. Specify a uniform limited time for each assessment session, such as, 2, 5, 10, or 15 minutes. The length of time should be in relation to the probable frequency of behavior. Remember, with extinction during these sessions, one may get an exacerbation of the rate and intensity of the problem behavior, as well as possible other disruptive behaviors. Therefore, for high frequency behaviors, a short time period should provide sufficient evidence of the problem’s initial operant level under extinction. If necessary, a control condition could be deployed, which would be the absence of the aversive event.

Here is an example of a trigger analysis of a possible extinction burst for an SME problem. A hypothetical inpatient male adult in a large institution for developmental disabilities engages in property destruction about three to four times a month. He will throw chairs and objects and kick furniture during these tirades. The board-certified behavior analyst Ms. Carr believes that such behavior is functional under conditions of lengthy tasks or chores. Prior to the destructive behavior, he will chant repeatedly about his dislike of certain chores assigned to him during the day. He will state, “I cannot do it! I cannot do it.” This verbal behavior (most likely a mand) seems to be part of the behavioral chain that involves property destruction at the end of the tirade (also a mand). Ms. Carr decides to deploy the trigger analysis evaluation method with this chanting behavior. She realizes that conducting a rate analysis of property destruction is not suitable given the disruptive nature of this behavior to the environment. Therefore, the session will be terminated if he attempts to throw chairs or objects or becomes aggressive to the staff person conducting the session. The session will also be terminated if he kicks furniture. Demands to engage in some chore will be presented each minute on a fixed time schedule (1 minute). Three sessions of hypothetical data are delineated in Table 4.11.

For SMA problem behaviors, the deprivation condition hypothesized to be the relevant EO for the problem behavior is produced. The time before the assessment session would deprive the event or item from the client to ensure the EO is in effect. If this presession deprivation is insufficient to create a strong EO, then it might be necessary to provide the item or activity at the onset of the session and then abruptly remove it. The occurrence of the target behavior during this evaluation procedure should not result in the delivery of the reinforcer.

Let us use a hypothetical child with autism to illustrate this analysis for SMA problems. You observe that this child screams at the mother to turn on the TV cartoon channel in the morning. You see that extinction is the functional approach for solving this problem, but you are unsure how long this child might scream if extinction will be deployed. You determine that a lengthy extinction burst might not result in treatment fidelity and want to discern if extinction is an ecologically feasible procedure to deploy. To obtain this data, the therapist asks the mom to delay turning on the TV for 5 minutes when the child sits down on the couch to watch TV. An interval recording method is selected to quantify the screaming behavior.

TABLE 4.11 n THREE SESSIONS OF HYPOTHETICAL DATA

Session Length of Session (Minutes)

Number of Chants per Minute

Session Stopped? When?

3/10 3 3 No

3/10 2 4 Yes, after second demand

3/10 3 7 total Yes, within 20 seconds

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You obtain data across a 5-day period for each of the two conditions: test and control. The following percentage of occurrences of screaming was obtained when the mom delayed the TV time by 5 minutes for 5 days (respectively): 100, 83, 100, 100, 83. The last session was stopped early due to destructive behavior. When the TV was not withheld, the percentage of intervals where the child screamed was 0%. Based on this data, you surmise that a functional approach needs to consider the aversive condition that may arise with extinction imposed for screaming behavior.

This method can also be valuable in evaluating functional treatment effects. Again the trigger analysis identifies the rate of the problem behavior, given the presence of the relevant EO and extinction for the target behavior. Collecting data using this assessment method can be particularly apt if it is difficult for staff to collect continuous data on the target behavior and alternate replacement behavior. The same procedural elements of the trigger analysis are deployed, except that the display of the replacement behavior identified in the treatment program would result in the removal of the aversive event (unpleasant social situation, lengthy task or chore, aversive physical stimulus, or difficult task or chore). This can provide excellent data in determining whether the intervention program has been successful in ameliorating the problem behavior while increasing the probability of the replacement behavior under the EO.

Alternate DE Form This option can also be applied for escape behaviors that are socially mediated (i.e., SME). The client or child is taught how to perform a series of acceptable behaviors that result in direct termination of the aversive events (Table 4.12). The following examples might help illustrate this replacement behavior option.

Nude Clients. How would this replacement behavior option apply to a client who engages in tantrum behavior until staff intervene? Simply allowing the client to change clothes or select his or her own clothing would do the trick! If the clothes the client is currently wearing are clothes that are less desired, or he or she is used to some other fabric (e.g., cotton, silk), this DE alternative form is well suited.

PROTOCOL FOR TRIGGER ANALYSIS SESSION

Target behavior: Screaming

EO: Withholding of favorite TV channel

Trigger analysis: Removal of TV for a 5-minute period in the beginning of the morning.

Method of Measurement: 10-second interval recording system, partial interval method of scoring within intervals

Protocol for implementing test session: When it is time for the child’s favorite cartoon to come on, and the child is sitting on the couch waiting for you to turn on the TV, delay turning on the TV for 5 minutes. You should use an oven timer to monitor the length of time. Do not turn on the TV during this time. Every 10 seconds, indicate on the data sheet whether the child screamed in a given interval by marking an x next to that designated interval. If the child begins engaging in destructive behaviors, note these and end the session, and mark the interval where that occurred. The percentage of occurrence would be computed only on the intervals up to that point.

Control Sessions: TV is not removed as the control condition with data still collected

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If the client is not capable of selecting clothes or self-dressing, then this behavior may have to be taught (i.e., prompted and shaped) in order for it to be a useful replacement behavior. In some cases, the chain of behaviors is already acquired but does not currently occur under the motivating operation. These clients do not spontaneously change clothes when uncomfortable because such a chain of behavior was (or would be) thwarted or punished by staff. Increasing their independent changing of clothes may require just a simple differential reinforcement plan, that is, let them do it in a private area. Staff have to be directed to allow such behavior when it occurs.

TABLE 4.12 n REPLACEMENT BEHAVIOR—MORE ACCEPTABLE FORM MAINTAINED BY NEGATIVE REINFORCEMENT

Reinforcer Undesired Form Desired Form

Terminating unpleasant social Interaction

Yells and screams until staff intervene

Leaves area

FUNCTIONAL TREATMENT: SME 4.4: AVERSIVE STIMULUS

Contingency Plan for Target Behavior If the student engages in tantrum behavior, he or she will not receive new clothes. Rather, after a short period of time following cessation of tantrum, the student will be prompted to go and select new clothes and put them on. Over time, prompts for the sequence of behaviors needed to produce this outcome will be faded until he or she performs this independently under the conditions of wanting new clothes to wear.

Contingency Plan for Replacement Behavior If the student changes clothes without engaging in any problem behavior, he or she will be allowed to wear those clothes. The student can change no more than three times in a given time period each day.

Escape Mand (Protest or Negotiation Behavior) This option can also be applied for escape behaviors that are socially mediated (i.e., SME). Again, two types of acceptable communicative responses to deal with aversive social situations are: (a) protesting behaviors and (b) negotiating skills. The following examples might help illustrate this replacement behavior option.

“I’m Bored.” This child (from a previous hypothetical example) had learned how to get a 5-minute break by throwing things. Its function was escape from relatively lengthy tasks (4.3 SME). Baseline data reveals that she will engage in such property-destructive behaviors once or twice in a half day. How could the teacher make throwing things ineffectual while reinforcing an alternate, more appropriate behavior? Suppose the student could request a 5-minute recess. Would that impact the student’s frequency of throwing things?

Here are the basics of the contingencies. In any given morning, this student is given only two recess cards that she can use. The same applies for afternoons. Whenever she needs to have a break, she can simply pull out one of her two cards, give it to the teacher, and set the timer for 5 minutes. Subsequently, after the break she returns to work. If she goes without a tantrum for a morning or afternoon period and also uses only two or fewer cards per morning, she earns five points. The following chart depicts the contingencies for target and replacement behavior.

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Enough Is Enough. The same methodology can be used for students with severe disabilities when problem behavior is maintained by SME of tasks. This young girl hits herself in the head and face when she is pressed to continue the task (SME 4.2: Lengthy Tasks/Chores/Assignments). In the past, when she engaged in this behavior, she was then moved to another activity, whereupon such self-injury ceases. If you were this child, what would you do the next time you felt you did enough work on a particular task or activity and wanted to change activities? Under the current social arrangement, you would continue hitting yourself! The following chart illustrates how self-injury can be disabled as a functional behavior while enabling protesting as functional in the same circumstance.

FUNCTIONAL TREATMENT: SME 4.1: SCHOOL ASSIGNMENTS

Contingency Plan for Target Behavior If the student engages in tantrum and property destructive behavior, any break cards left are immediately removed for the remainder of the morning or afternoon session. If she cannot be stopped from continuing to throw materials, she will be removed from the area for the protection of other students and placed in time- out until she calms down. Following time-out, she is told that she has extra work to do during recess at the principal’s office area (Reverse Premack Principle). Further, she does not earn five points and has to return to the assignment during the class period.

Contingency Plan for Replacement Behavior If the student uses a recess card, she can take a 5-minute recess break. Any period (morning or afternoon) when the student does not go over her recess cards and has no tantrums, she earns five points toward a selected Friday video at her parents’ home that evening. She has to earn 30 points by Friday afternoon in order to earn the Friday video (i.e., no more than two opportunities where she did not earn points).

FUNCTIONAL TREATMENT: SME 4.2: LENGTHY TASK//CHORE/ASSIGNMENT

Contingency Plan for Target Behavior If the student engages in self-injury, the current activity is maintained. Staff would prompt the student to perform the communicative replacement behavior.

Contingency Plan for Replacement Behavior If the student performs the protest behavior, the staff change the activity. Such behavior may have to be prompted in the beginning prior to the self-injury for it to occur in the presence of the student’s motivational condition to escape the activity. This is assuming that, in most cases, the replacement behavior is not currently in the repertoire of the student (see Inept Repertoire Category section of this chapter).

Table 4.13 depicts how protesting behavior can function as an effective replacement behavior with an SME problem behavior. The four different subcategories of SME are used to illustrate how protesting behavior can produce an escape of the relevant aversive event.

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Tolerance Training Option In many circumstances, protesting an instructional task or required event is not feasible. For example, if an elementary grade student does not want to do math today, it is unacceptable to simply opt out. To allow the child to escape whenever he or she says “I don’t feel like doing this today, sorry, it is not in the cards,” would not be in the child’s long-term best interest. Although such a strategy may significantly reduce the level of problem behaviors in math period for this child, it would affect the child’s progress on math content. Therefore, protesting is not always an acceptable alternate replacement behavior.

For these circumstances there is a better option. In tolerance training, the task is terminated when a certain time interval passes in which no target behaviors occur. Therefore, escape from the aversive condition is conditional upon “not doing the behavior” for some designated period of time. To use tolerance training, identify a reasonable DNRO interval to begin the program based on baseline data.4 If the client is successful in not engaging in the target behavior for that period, the parent or staff allows the client to leave the activity and engage in a more preferred event.

Out-of-Seat Behavior. Many young children have difficulty staying in their seats for a protracted period of time. Although most of these children learn over time to tolerate sitting in a seat or desk, or sitting on a carpet square in preschool, some children do not. They frequently get up, wander around, and disrupt the learning environment. The basic strategy of tolerance training can be used to progressively develop continuous in-seat behavior.

After deriving the average in-seat interval from baseline data, the DNRO interval is set at the average in-seat interval. If the child does not get out of his or her seat once during the interval, the child earns several minutes of out-of-seat time (hence the Premack contingency). If the child gets out of his or her seat unauthorized during this time, the child is returned to the seat and the timer is reset for the full DRO interval. As the number of times the DNRO interval is reset decreases, the length of the DNRO interval can be progressively increased.

TABLE 4.13 n PROTESTING BEHAVIORS ACROSS DIFFERENT SME CATEGORIES

Target Behavior: Self-injury Hypothesized Maintaining Contingency: SME 4.1, SME 4.2, SME 4.3, SME 4.4

SME 4.1: Unpleasant Social Situation—another student tantrums in a class for students with autism

Student raises hand when feeling uncomfortable, and is removed by staff from the area where all the screaming is going on.

SME 4.2: Lengthy Task—student is in a 30-minute story time

Student signs “enough,” and staff take the student out of the story time to engage in play skills training.

SME 4.3: Difficult Task—student is presented with a vocal language task in which the student is capable of making only four sounds

Student signs “help,” and the teacher helps with signing the word instead of pressing for vocal response. (Note: in this case the Premack option is better suited.)

SME 4.4: Aversive Stimulus—student is given a peanut butter sandwich that has meat on it

Student raises hand to alert teacher of need to communicate, points to the peanut butter sandwich, and signs “No.” Teacher then removes sandwich and, upon inspection, sees the problem.

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The 20-Minute Child. This hypothetical child hits the desk to temporarily terminate the presentation of a lengthy instructional task. When this child hits the desk, the teacher “deals” with the problem behavior, thus temporarily terminating the instructional assignment. If an FBA reveals that this temporary halt to task engagement is maintaining the behavior (SME 4.2, task duration), then such a contingency obviously needs to be disabled, while a more appropriate behavior needs to be enabled to produce escape.

First, the teacher would no longer substantially interrupt the instructional presentation to “deal” with the target behavior. What would occur contingent on the target behavior is the resetting of the DNRO interval to the full amount. With this contingency, the target behavior no longer results in teacher mediation of temporary escape. Rather, the target behavior serves only to lengthen the instructional period, via the resetting of the DNRO interval. What happens when this child goes the entire interval without engaging in target behavior? The teacher would then allow the child to terminate engagement in the current task and spend a designated amount of time on a more preferred task. This plan strengthens one set of behaviors (i.e., behaviors other than the target behavior), while weakening a problem behavior (target behavior) by selectively producing escape from the task.

Premack Principle (Escape) The Premack contingency can also be utilized for SME behavior. The completion of a designated number of tasks results in escape and avoidance of further tasks or chores for some period of time. The use of a Premack contingency is well suited as a strategy for developing increased persistence at work or in school. A break from work or school assignments can be progressively developed until the persistence needed for most jobs or classrooms is achieved.

This strategy would require the client to complete a small number of designated tasks. Once these are completed to criterion, the client is allowed to take a break from work. Setting up a Premack contingency would be effective in eventually reducing the number of behavior problems that previously terminated the work task directly.

The following examples depict the use of this contingency for SME 4.0: Problem Behaviors.

JUST BECAUSE IT SOUNDS GOOD DOES NOT MEAN IT WILL WORK!

Curriculum modification as an antecedent positive behavioral intervention strategy is often recommended. Its indiscriminate use can have little or no effect on some target behaviors whose function is unrelated to the task or instruction. For example, if the target behavior’s function is one of accessing adult attention (i.e., a diagnosis of SMA 2.1: Adult Attention), then modifying the curriculum is not clinically indicated and is probably superfluous. Changing the curriculum will have an inconsequential effect on the rate of the target behavior. In contrast, modifying the curriculum is clinically indicated when the target behavior is diagnosed as SME 4.3: if  the curriculum modification removes the source of the difficulty in the current instructional material. Behavioral interventions should be pre- scribed as a function of the controlling variables for the particular target behavior, not haphazardly.

Tolerance training would be effective only if a child’s out-of-seat behavior is the result of the lengthy condition of instruction (or being required to sit for lengthy periods). If task difficulty is the condition driving the behavior (DE 3.3: Difficult Tasks/Chores/Assignments), then curriculum modification is needed in addition to tolerance training or another replacement option. The question for SME problem behaviors occurring during instruction should be: Is it too long or too difficult (or both)?

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I Need a Break, My Brain Is Swelling. How would the Premack option apply to the tantrum behavior of the mainstreamed fourth-grade student? The contingencies that would be in effect for the target behavior of tantrums (SME 4.2: Lengthy Tasks/Chores/Assignments) as well as the replacement option are delineated in the following box.

FUNCTIONAL TREATMENT: SME 4.2: LENGTHY TASKS

Contingency Plan for Target Behavior Contingent upon tantrum behavior, another assignment will be added to the student’s task assignment board (Reverse Premack Principle).

Contingency Plan for Replacement Behavior A set number of tasks/assignments is issued at the beginning of the independent seat work session. When all the tasks are completed, the student earns the remainder of the time to engage in more preferred activities (listed on a menu chart). Once the period is up, the same contingencies are put in effect for the next content instructional session.

CIPANI REPLACEMENT FUNCTION CLASSIFICATION SYSTEM How many times have you heard a teacher or parent say, “She can do that! She is just being lazy. I know she knows that stuff. She just does not finish her work because she is lazy [implying motivation is the sole issue]. That is why I have taken away recess every day for the last 30 school days. Someday I will get to her. I will teach her that she needs to be a responsible student and finish her work.”

Obviously this plan needs a critical examination! But why is it failing? There exists a faulty conjecture about the student’s capability. This hypothetical teacher strongly believes that the student’s “motivation” is the sole factor in whether the daily assignment will be completed or not. As a result of this assumption, the teacher determines that utilizing consequences for failing to complete the assignment is the requisite strategy. Although this strategy might make “sense” if the child is capable of performing the designated assignments competently, it is doomed to failure if the child needs active instruction in order to perform the task assignment to a mastery level of performance. If the child is incapable of competently performing the specific requirements of the assignment, all the reinforcement in the world, or removal thereof, will be of little utility. Contingency rearrangement “works” only if the behavior to be increased is in the current repertoire in the form required for such reinforcement.

Perhaps an example from the animal laboratory would be informative and entertaining. Let us say Ms. Jones, an undergraduate student in an animal-learning class, was given an assignment. She has to teach her slightly food-deprived rat to press the bar in the operant chamber to get food. She accomplished that in a reasonable period of time. She notices that her rat, when not pressing the bar, enjoys the following activities while in the chamber: sniffing one of the corners, grooming its underbelly, and standing up on its hind legs. These behaviors occur with some regularity once the rat has received some food for its bar-pressing responses.

Ms. Jones’s lab instructor now gives the class a second assignment. They are to place bar pressing on extinction, while selecting an alternate replacement response that will now result in food. If Ms. Jones wants to complete this second assignment as quickly as possible, what replacement behavior should she pick? If she selects a behavior she has not seen before, will simple differential reinforcement be effective in developing such a behavior? When the animal fails to access reinforcement at all, would it be a matter of improper motivation? Would it be more prudent for Ms. Jones to select “standing up on hind legs” as the behavior that should produce food? Why? (Table 4.14).

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As this example illustrates, selecting an alternate behavior that is already in the repertoire merely requires a simple rearrangement of reinforcement contingencies. However, selecting an alternate behavior that is not currently in the repertoire of the animal requires more than differential reinforcement. If Ms. Jones selects a behavior that is already at some level of occurrence, the process will ensure that the transition to such a new functional behavior will be relatively easy. Just as Ms. Jones must diagnose the strength of potential replacement behaviors, so, too, must the applied behavior analyst.

Too often, implicit or explicit assumptions are made about the presence or strength of the selected alternate replacement behavior. Evidence demonstrating the strength of the selected replacement behavior during the assessment process is rarely considered or collected. As a result, mistakes in the subsequent intervention plan can happen. It is therefore essential that one consider the strength of the alternate acceptable behavior that is selected to replace the problem behavior’s environmental function in the functional treatment plan.

The three diagnostic categories in Table 4.14 are offered to classify the current status of the strength of a selected replacement behavior in a client’s repertoire (adapted from Bailey & Bostow, 1976; Cipani & Trotter, 1990). These three diagnostic categories are: (a) misdirected contingencies, (b) inept repertoire, and (c) faulty discriminations.

TABLE 4.14 n CIPANI REPLACEMENT FUNCTION CLASSIFICATION SYSTEM

Diagnostic Category Nature of Problem

Misdirected Contingency Problems Failure to make alternate behavior more functional than problem behavior

Inept Repertoire Problems Skill deficit with respect to form and/or accuracy, and fluency of performance)

Faulty Discrimination Problems Lack of generalization to relevant situations

MISDIRECTED CONTINGENCIES CATEGORY In this diagnostic category, alternate replacement behaviors do not occur as frequently as needed because they produce a rate of reinforcement that is far less (or nonexistent) than the reinforcement ratio for problem behaviors. For example, while in the grocery store, a little girl nicely asks her mother for a box of cookies.

Child: Mommy, can I have a box of cookies? Mother: (not wanting to fulfill that request, she ignores it) Child: I asked if I can have the cookies, please? Mom: No cookies today! Child: But I really want the cookies. (begins crying) Mom: I don’t want you to eat too many cookies. Don’t you think that you should stop

eating as many cookies as you do? Child: I don’t eat that many. (continuing to cry) Mom: (begins moving away from cookies) Child: (Cries and falls on the floor) Mom: Get up. You are making a spectacle of yourself. If you will be good, I will get

one box after I get the chicken for dinner. Child: (gets up and gradually stops sobbing while holding onto the shopping cart)

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What just happened? The child asks nicely but is told that she is not getting cookies. Then the child begins crying and screaming for the cookies. The mother continues to explain why she cannot get cookies for her daughter today. After several minutes of the child’s tirade with the mother’s retorts, the mother gives the child the cookies (to terminate the tantrum when she falls to the floor of the grocery store). We can all see that the tantrum serves an SMA function (2.3 SMA: tangible reinforcer). However, what is important to note in this hypothetical scenario is that an acceptable behavior did occur, yet, it was not as effective (from the child’s viewpoint) in getting cookies as the tantrums. We would expect tantrums to become more probable and requesting nicely less probable (and profitable), given these misdirected contingencies. The current social environment selects tantrums as the means to getting cookies, not requesting. Yet, this parent will be adamant about not giving cookies, saying her child should learn how to not beg for things. She will often forget that cookies are given on occasion, and unfortunately, it is the undesirable behavior that wins out.

What is needed is a change in the rate of reinforcement for the replacement behavior and the current target unacceptable behavior. The child is capable of requesting. To solve this behavior problem, requesting just needs to have a stronger density of reinforcement relative to tantrum behavior during shopping outings. Perhaps the child can earn a desired item if she goes for a period of time without asking or throwing a tantrum during the shopping trip5 (if such a behavioral criterion is also in the current repertoire).

Similarly, suppose a male client demonstrates a high rate of tantrum behavior to escape or avoid certain staff requests. When this client is requested to perform some cleaning activity in his room, such as dusting or vacuuming, he throws a tantrum. He will often verbally protest such a task vociferously, and then he slams doors, kicks furniture and walls, and walks outside. When the client does occasionally comply, such compliance to one request is typically followed by the presentation of additional tasks. If he dusts the table in his room and completes the task, the staff praise him for his work and then tell him to vacuum the rug! Compliance seems only to bring on more work. However, severe tantrums result in the staff terminating current and future task demands until a later time. The staff claim that the client is too upset to perform chores during those times, and they decide to try asking him when he is feeling better.

What is the contingency analysis of behavioral function in this example? Terminating task demands occurs when the client throws a tantrum. In contrast, completing an assigned chore or task results in staff issuing additional requests (while we have him on a roll!). It is not that some reasonable acceptable behavior is nonexistent. Rather, when it does occur, it is followed by another chore, thus creating an aversive EO at that point in time. Tantrum behavior is more capable of getting the desired results: temporary termination of the task or chore demand. The questions in Table 4.15 help you determine if a misdirected contingencies diagnosis fits the nature of the replacement behavior problem.

TABLE 4.15 n QUESTIONS FOR MISDIRECTED CONTINGENCY DIAGNOSIS

1. Does an appropriate replacement behavior occur at all, under the same or similar conditions as the problem behavior? Record both the occurrence of the target problem behavior as well as any occurrence of an alternate replacement behavior when the motivational condition is present (i.e., state of deprivation or state of aversion).

2. If the client performed the appropriate behavior recently, was it successful? Was the behavior effective at producing either access to a desired activity or escape from an aversive situation?

3. Does the problem behavior appear to be maintained because the reinforcement contingencies are of greater density for the problem behavior relative to the replacement behavior?

4. If the problem behavior was eliminated, would the alternate replacement behavior exist in the client’s repertoire? Would it increase in frequency if reinforced (similar to Question 1)?

5. Does the rate of the replacement behavior vary across time, ranging from low levels on some days or time periods to some days on which there is an adequate level of the behavior?

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The basic characteristic of this classification category is the misdirected reinforcement contingencies for both the problem and replacement behaviors. Problems in this diagnostic category can be simply addressed by rearranging contingencies in favor of replacement behavior. Shifting the schedule of reinforcement to be denser for the replacement behavior, while eliminating (or at least drastically reducing) the rate of reinforcement for the problem behavior, should produce the desired effect. If one has accurately identified the maintaining reinforcer for either the access or escape function, this strategy will be successful in altering the rates of problem and replacement behaviors in the desired directions.

INEPT REPERTOIRE CATEGORY Not all cases involve merely increasing an already existing operant behavior as the replacement function. Many children and adult clients, particularly individuals with severe disabilities, often engage in the problem behavior because of the lack of alternate appropriate behaviors in their repertoire. Communication deficits often translate into a person’s inability to produce an appropriate response to allow care agents to meet the individual’s needs. Aberrant behaviors such as self-abuse, tantrums, and aggression often fill the void and eventually result in the delivery of the desired reinforcer. Such problem behaviors are often strengthened through reinforcement because of the substantial lack of an alternate competing response.

This diagnostic category involves the client not having the capability to perform an alternate replacement behavior that recruits reinforcement. An inept repertoire can exist because the client cannot perform the target replacement behavior. As an example, a child with autism may throw a tantrum when wanting cookies. If one assumes the child is capable of requesting the cookies, an adult would wait until such occurs before giving the cookies. However, if the child is either nonvocal, or not capable of asking nicely, then one will have to wait a long time. What happens then? Staff eventually succumb to reinforcing the target problem behavior with the cookies. Failure to diagnose this situation accurately leads to inevitably making the problem behavior worse, both in frequency and severity.

Misdiagnosing inept repertoire problems can have disastrous results with escape functions as well. A client may act aggressively against teaching personnel under conditions of excessive demands or requests. The client may not be capable of communicating to the staff that he or she does not understand the task, that the number of demands is excessive, or some other such factor. The staff understand that aggression should not function to escape demands, but they are not aware that more acceptable forms of protest, negotiating, or requests for help need to be taught to the client. Staff may assume the client “knows” how to communicate his or her needs. Consequently, they attribute the aggressive behavior to being “spoiled.” The following real-life case illustrates this misdiagnosis and how contingencies are ineffective with an inept repertoire.

I Still Will Not Do My Work! I was consulted on a case in the mid-1990s involving a boy who was placed in a mainstream third-grade class but also served part time in a special day class for students with mild disabilities. My involvement occurred as a result of county mental health’s involvement in the family situation. The involvement of mental health and Child Protective Services was the result of a family problem, whereupon he was removed from the home and placed in foster care. Prior to his removal from his biological parents, he was expelled from school. His expulsion from school was a result of attacking two teachers and the principal in two separate incidents. When he returned back home, he was placed on home instruction, 1 hour a day.

Unfortunately, his home instruction was not going well. Every day the resource teacher would show up after school hours. On a regular basis, she would leave within 20 to 25 minutes when he refused to do his assignments and work that she brought for him. Of course, her

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contingent leaving upon his initial verbal refusal and subsequent failure to engage in the assignment was not a wise behavioral intervention. Such a plan would make verbal opposition very viable in terms of its ability to avoid performing the assignment. I felt that what was primarily needed was a powerful contrived reinforcer to compete with the power of the avoidance contingency inherent in the home instruction setting.

As a result of some interviews of school staff and his resource teacher, I discovered an interesting phenomenon regarding this student. Prior to his expulsion, he would go into his former teacher’s first-grade class and help her with the first-grade students every so often. This teacher indicated that she did not have any problems with him and that she did not have problems with him when he was in first grade. Here was the powerful unique reinforcer needed, and it was something to which he currently had no access. The contingency I designated was the following: Every day you complete your work during the home instruction period, you earn a star. When you have four stars, you can go on campus and help the first-grade teacher. This had all the makings of a successful intervention on paper. As a side note, it took some time on my part talking to the principal about the student’s return to campus. The principal required the presence of a psychiatric technician everywhere he went, funded by mental health, before relenting to this request.

However, the first week results were discouraging to say the least, with the student having earned only one star. This result was confusing to me. I wondered why he would not want to engage in his assigned work, given it was only about 45 minutes of work at most. I innocently asked the resource teacher how the assignments were prepared. Her answer was the shining light: The third-grade teacher prepared them. Of note is the following: This is a student who functions competently at a first-grade level in reading and math. This student was inept when it came to third-grade level content in math and reading. The third-grade material created an instructional mismatch. Even a strong contingency would not override his aversion to workbook material that he was incapable of performing. Once that instructional mismatch was fixed, the contingency worked just fine, with him reliably earning four stars in about four days. He did so well the resource teacher advanced the idea to bring him back to the school.

An inept repertoire can still exist even if the target behavior can be performed. In some cases, a client may be able to perform the replacement behavior but not fluently. In this circumstance, an inept repertoire is still relevant. The inept repertoire consists of an appropriate behavior that may occur, but takes too long to occur. A child who uses his fingers to add, subtract, multiply, and divide may be able to come up with a correct answer, but he will need more time to complete an assignment. Hence, simply placing a reinforcement contingency on completion may do little good. One can only go so fast on one’s fingers! Teaching this child to memorize the facts would prove beneficial. Typing on a keyboard with one finger is obviously less fluent than proficient keyboarding skills. If typing takes too long with the one-finger approach, the individual will probably prefer handwriting. In contrast, the person who has great keyboarding skills will probably prefer to type an essay out on the computer rather than write it by hand.

Table 4.16 presents questions to pose when considering an acquisition diagnosis as well as the data sets needed to answer these questions.

TABLE 4.16 n QUESTIONS FOR AN INEPT REPERTOIRE DIAGNOSIS

1. Does the appropriate replacement behavior occur at a zero or nonexistent level across time and stimulus conditions?

2. Does the replacement behavior occur, but not at a fluent level that produces reinforcement? 3. Under the best circumstances, does the client appear unable to perform the alternate

replacement behavior either in topography, level, or fluency?

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FAULTY DISCRIMINATION CATEGORY This diagnosis presents frequency data for the replacement behavior that can mimic the first diagnostic category, misdirected contingencies. The telling sign that it is not a misdirected contingency problem is that the replacement behavior occurs only under restricted conditions, that is, a failure to generalize.

Let us use a previous example to illustrate such a stimulus control problem. The child may be able to request cookies when wanting them, but this behavior occurs only when the mother is at home in front of the cookie jar. Under these conditions, requesting occurs regularly when the child wants cookies. However, if the mother is not present (e.g., the father is the only one in the room), requesting does not occur. Rather, the child throws tantrums and whines when the father is present, which the father reinforces. Additionally, the tantrum also occurs if the mother and child are in a different area of the house or outside. This describes a scenario that illustrates a stimulus control problem with the replacement behavior.

Faulty discrimination as a diagnosis is different from the inept repertoire diagnosis in that the behavior is in the current repertoire of the client, but its occurrence is limited to certain conditions. With faulty discrimination problems, the replacement behavior would occur (with regularity) to one setting or one person, but does not occur to other, different settings (or persons) at an acceptable level. Table 4.17 presents two questions to consider in evaluating the possibility that a replacement behavior should be diagnosed as a stimulus control problem.

These problems are treated with generalization strategies, whereby the behavior is transferred to new settings, people, or time. If the replacement behavior occurs in one to a few settings and the treatment goal is to generalize the behavior to settings and antecedent conditions where it is not currently occurring, then a systematic approach to programming for generalization needs to occur. Reinforcement of the behavior when it does occur in the new target settings or conditions will certainly be a part of the program. However, the design of the behavioral intervention for the replacement behavior will involve methods to generalize the behavior from its current antecedent conditions to new conditions. Strategies involving discrimination and generalization training and errorless transfer of stimulus control are appropriate.

An excellent example of this classification category (faulty discrimination) is selective mutism. Some children, who are able to vocally communicate in at least one setting (usually home environment with parent(s)), fail to do so in another (usually school setting with teachers and classmates). The vocal behavior fails to generalize to such environments, sometimes in spite of efforts at the school to get the child to “use his or her words.” In some cases, nonvocal communication can persist across several grade levels.

Is it ADHD? Narrated PowerPoint Presentation

www.springerpub.com/fbadt ASSIGNMENT: IS IT ADHD? NARRATED LECTURE

After reviewing the narrated PowerPoint lecture entitled “Is it ADHD?” submit the following with a target behavior involving on-task behavior:

1. A table or graph depicting a misdirected classification in an ABA design 2. A table or graph depicting an inept repertoire classification in an ABA

design

TABLE 4.17 n QUESTIONS FOR FAULTY DISCRIMINATION DIAGNOSIS

1. Does the replacement behavior occur under one or just a few antecedent conditions? 2. Does it not occur under other relevant antecedent conditions?

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Diagnosing the current strength of the behavior or behavioral criteria designated for the replacement function is just as necessary as the prior assessment and diagnostic activities for the problem behavior. In some circumstances, to increase the designated replacement behavior, you need to alter just the functional contingencies for problem and replacement behaviors. However, in other cases, such a strategy would prove ineffective in increasing the alternate behavior. If the replacement behavior is nonexistent in the client’s repertoire, merely strengthening the rate of reinforcement for the replacement behavior would not have the desired effect. In these cases, it is necessary to utilize techniques that shape and build a new behavior. It is critical to understand the nature and extent of the replacement behavior in the client’s current repertoire. The focus is on determining the reasons for the low (or nonexistent) occurrence of alternate acceptable behavior.

SUMMARY This chapter presented behavioral treatment options for each of the four major classification categories of problem behavior, as well as a classification system for replacement functions. The next chapter provides a further delineation of these replacement function options with a clinical hypothetical example illustrating the process from functional behavioral assessment to the diagnosis of the problem behavior’s function to functional treatment using the designated replacement behavior option.

ASSIGNMENT: THREE-PHASE TREATMENT MODEL FOR SELECTIVE MUTISM

After reviewing the narrated PowerPoint lecture entitled “Three-phase treatment model for selective mutism,” write a paper that discusses a concurrent schedule of reinforcement as used in the treatment of selective mutism. Please address the following points in order regarding the Phase 2 procedures:

1. What are the two different behaviors/performances that result in the reinforcer being delivered, and what happens when the schedule for either behavioral requirement is fulfilled?

2. How is vocal behavior progressively made more prevalent (i.e., increase in words, sentences exhibited) in the session in Phase 2?

3. What is the utility of having a different, but demanding requirement for reinforcement for nonvocal behavior? Why is a concurrent schedule (two different requirements) needed to make vocal behavior occur?

Three-phase treatment model for selective mutism Narrated Presentation

www.springerpub.com/fbadt

SELF-ASSESSMENT EXERCISES

• Explain how an access mand replacement behavior option can be used for SMA functions. • Discuss how the DRL group contingencies was used by Ron Pekarek to decrease

the arguing behavior between Antonio and his sister. Why was a group contingency necessary? What might be the result if the parent had to determine who started the argument (in order to provide a contingency for that child only)?

• Examine the case of the hypothetical individual who rips off clothes so that staff will give new ones? Explain how delay of gratification training can be used to progressively increase a tolerance of nonpreferred clothing.

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Notes 1. For review of the differential reinforcement procedures, including the DRO, the reader

is enjoined to consult the pdf in the student portal entitled “Differential Reinforcement Procedures for Access and Escape Functions.”

2. I have termed this reversal of conditional probabilities typical of reinforcement operations the Reverse Premack Principle.

3. See pdf in student portal for “Differential Reinforcement Procedures for Access and Escape Functions.”

4. For specifics of this program using DNRO, the pdf “Differential Reinforcement Procedures for Access and Escape Functions” in the student portal should be consulted.

5. For a free downloadable pdf resource addressing such problem areas for parents, “A Clinical Treatment Guide to 10 Common Behavioral Pediatric Problems”, go to: www .freepsychotherapybooks.org/behavior-therapy/product/109-a-clinical-treatment -guide-to-10-common-pediatric-behavioral-problems

REFERENCES Bailey, J. S., & Bostow, D. E. (1976). Research methods in applied behavior analysis. Tallahassee, FL: Copy Grafix. Cipani, E. (2008a). Analogue assessment for replacement behaviors. International Journal of Behavioral Consultation and Therapy, 4, 374–379. Cipani, E. (2008b). Triumphs in early autism treatment. New York, NY: Springer Publishing. Cipani, E., & Trotter, S. (1990). Basic methods of behavioral intervention. In E. Cipani & A. F. Rotatori (Eds.), Behavior modification in special education (pp. 137–201). Greenwich, CT: JAI Press. Iwata, B. A. (2006, May). On extinction. Paper presented at the meeting of the Association for Behavior Analysis, Atlanta, GA. LaVigna, G. W., Willis, T. J., & Donnellan, A. M. (1989). The role of positive programming in behavioral treatment. In E. Cipani (Ed.), The treatment of severe behavior disorders: Behavior analysis approaches (pp. 55–84). Washington, DC: American Association on Mental Retardation.

• Examine the “Potato Chip” example. Delineate how the Premack contingency was utilized. What happens to the amount of extra chips a client consumes when she or he has to engage in a task requirement to earn potato chips as opposed to having to ad-lib access?

• Contrast a misdirected contingency function with an inept repertoire function for classifying the potential replacement behavior. Which one would need contingency manipulations only and why?

• Describe the basic elements of an experimental test to determine if the replacement behavior is lacking as a result of an inept repertoire, or due to misdirected contingencies. On what behavior is reinforcement contingent upon in the control condition? What behavior gets reinforced in the test condition? Why is this conducted?

• Present a graph of data that reflects a misdirected contingency classification for a hypothetical replacement behavior. Do the same for an inept repertoire.

• Describe what a faulty discrimination function is.

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Mazaleski, J. L., Iwata, B. A., Vollmer, T. R., Zarcone, J. R., & Smith, R. G. (1993). Analysis of the reinforcement and extinction component contingencies with self-injury. Journal of Applied Behavior Analysis, 26, 143–156. Rolider, A. (2003, September). The use of antecedent analysis driven intervention to treat complex anti-social behavior among children in school settings. Paper presented at the meeting of the Florida Association for Behavior Analysis, St. Petersburg Beach, FL.

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5Functional Behavioral Treatment Protocols for SMA 2.0: Target Behaviors In this chapter, the material presented in Chapter 4 is expanded to provide a treatment protocol for each replacement function option delineated for socially mediated access (SMA) target behaviors. The treatment protocols for direct access (DA) are the same as the SMA protocols, except for some minor variations in the procedures for dealing with the occurrence of the target behaviors. These variations are explicated in each replacement function option.

For SMA target behaviors, the following protocols are presented in this chapter:

ll Alternate DA Form ll Differential Reinforcement of Low Rate (DRL) Group Contingencies for Peer Attention ll Omission Training (Differential Reinforcement of Other Behaviors, or DRO) ll Noncontingent Reinforcement (NCR) with Extinction ll Premack Contingency Option ll Access Mand (Request) Option

This chapter also contains a protocol for a treatment program called noncontingent reinforcement. This program was not delineated in Chapter 4 because it does not readily address the function of the target behavior or the development of the replacement function (not one specified). Rather, it works as a result of altering the motivational condition of the client in one of two ways. In the case of target behaviors maintained by positive reinforcement, the rate of the target behavior is reduced by abolishing the value of the reinforcer for the client. The specific reinforcer is presented noncontingently according to a time schedule In this case, it may also establish the conditions for extinction by disrupting the contingent pairing of the target behavior and the reinforcer.

All the protocols in this chapter, with the exception of noncontingent reinforcement (NCR), contain a functional arrangement of treatment contingencies. The target behavior’s function is disabled, while the replacement behavior’s function to the relevant reinforcer is enabled.

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SMA FUNCTIONS: ALTERNATE DA FORM Brief Description In this replacement behavior option, the desired reinforcer is produced by the client engaging in a chain of behaviors that produces the item or event, independent of anyone else’s assistance.

To implement a DA replacement option program, you must determine what chain of behaviors can directly produce the reinforcing items or event. If the person can fluently perform the requisite chain of behaviors, a simple rearrangement of contingencies is required. Performance of the designated chain of behaviors is allowed to produce the reinforcer, whereas previously it was probably disabled. Concurrently, extinction of the target behavior (i.e., socially mediated) is programmed.

If the person does not currently possess the DA behavior, the behavior must be shaped to produce an effective response (discussed in Chapter 4). In some cases, the entire chain of behaviors may have to be taught. In other cases, a few components of the chain may be lacking.

In some cases the client can perform the chain of behaviors, but not fluently (i.e., with acceptable speed and accuracy). If that is the case, fluency training is required. Once the client has acquired fluent performance of the chain of behaviors, differential reinforcement as delineated in this program is implemented. The use of differential reinforcement disables the target behavior’s function, while enabling the function of the DA behavior.

The advantage of this replacement behavior option is that it allows the client to independently obtain reinforcing items without reliance on other people or having to use communication or social skills. The DA option develops a specific chain of behaviors that  will continue to be functional for the client over time. Once these behaviors are acquired, they can be utilized in other situations through the process of shaping and generalization.

Terms Trigger analysis: Setting up all the context conditions hypothesized to occasion the target

behavior, and documenting the occurrence (or lack thereof) of the target behavior and the DA replacement behavior.

Apparatus Data sheets—See Form 5.1, “Simple Frequency Data with Rate Formulas” Reinforcing items or events—The specific tangible items or event that have been identified

as the maintaining reinforcers. These will be made available for DA and must be readily available without assistance from other people.

Baseline Measurement There are two different pieces of information you need to obtain. First, you need to determine how often the target behavior is occurring under relevant conditions. Additionally, the frequency of occurrence of the proposed DA replacement behavior under the same conditions is needed.

The frequency measure is best suited for both these requirements. You (or the designated staff person) simply count each time the client engages in the target behavior as well as each time the client performs the DA behavior under the same conditions (see Form 5.1). When considering this option, baseline rates for the DA replacement behavior are typically at or near zero.

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Trigger Analysis (See Form 5.2) 1. Set up (contrive) or wait for (capture) a situation in which the person is very likely

to want access to the desired item or event. You must ensure that the motivational conditions are as strong as possible. This can be contrived through temporary deprivation of the desired items.

2. Present a stimulus that signals that the item is now available to the person. 3. Observe the person’s behavior, and record if the target behavior or the chain of DA

replacement behavior occurs. 4. Record the time taken to initiate the first response. 5. Record the time taken to complete the chain of behaviors and obtain reinforcement. 6. If the replacement behavior was attempted (or performed), record which steps

were completed and any prompts required to facilitate the performance of the steps.

7. Record if the reinforcing item or event was provided by the staff or care provider. 8. Repeat steps 1–4 at least six more times. 9. Graph or display the data across all baseline sessions.

DA Procedures If the baseline data indicates that the person is not performing the DA behavior, start by teaching the behavior using discrete trials. If the baseline data indicates that they are able to perform the behavior, then skip to incidental teaching.

Discrete Trials

1. Present a prompt for the person to perform the first step in the task. 2. Provide reinforcement contingent on completing the behavior or chain of behaviors. 3. If the person does not complete the task or engages in the target behavior, provide an

additional prompt to help the person complete the next step. 4. Provide reinforcement, preferably access to the reinforcing item or event you want

the person to directly access with this behavior. 5. Record data. 6. On each successive trial, shape more independent responding by reducing the level

of prompt provided. 7. Once the person is performing the task without the need for additional prompts,

change to incidental teaching method.

Incidental Teaching

1. Observe for conditions under which the person would usually engage in the target behavior.

2. If the person directly accesses an item or event, allow the person to do so. 3. If the person does not access the item or event, provide a prompt to engage in the DA

behavior. 4. If the person does not complete the task or engages in the target behavior, do not

provide access to the reinforcer (extinction); instead provide an additional prompt to help the person complete the next step.

188 Functional Behavioral Assessment, Diagnosis, and Treatment

5. On each successive trial, shape more independent responding by reducing the level of prompt provided.

6. Record data.

Ensure Access to Reinforcement!

It is critical that the desired reinforcer be available on a continuous schedule (every time) while the person is learning to perform the DA replacement behavior (or chain of behaviors).

If the rate of the DA replacement behavior becomes too high with ad lib access, you may consider setting up a Premack contingency as an additional option to reduce the rate of access.

If utilizing this behavior option for DA behaviors: Utilize the same baseline and treatment procedures as above, except that chain interruption would occur instead of extinction when the target behavior is displayed.

How It Works When the client or child is motivated to access a particular item or event, and can do so directly, it will become functional very quickly. The DA behavior will probably produce the item or event at a higher rate and more reliably than the target behavior, which required other people to be involved. There is no reliance on ancillary skills, such as initiating a social interaction or making a request.

Hypothetical Example

I Want a Sandwich, Please

Bill is a person with developmental disabilities living in a group home, and he was referred for services due to “tantrums and yelling.” Mr. Hewlet was assigned the case and began the assessment process by reviewing the data the group home staff were keeping. He then proceeded to interview the staff of the home to understand the definitions of the targeted behaviors and gain information about the conditions under which the behavior occurred.

The data for the previous week are displayed in Example Form 5.1A. Mr. Hewlet needed to determine if the frequency counts were a reliable measure of the

referred target behavior. He asked the staff to describe what the target behavior looked like the last time it happened and if there was much variation across occurrences. The staff reported that the behavior was the same each time. Bill would walk around the house and sit at the

Example Form 5.1A n Simple Frequency Data

• Client: Bill Chart Started:_______________

Day/Month/Year

• Behavior: Tantrums/yelling

• Total Observation Time: min (___, ___-minute session/day)

• Session Length: min

• Number of Days: 7

• Place an X on the appropriate day box each time the behavior occurs

1 2 3 4 5 6 7 Totals

Target behavior xxxx xxxxx xxx xxxxx xxxx xxxxx xxxxxx

Daily rate 4 5 3 5 4 5 6 32

5 Functional Behavioral Treatment Protocols for SMA 2.0: Target Behaviors 189

dining room table briefly. He then would get up and walk around the house stomping his feet, briefly sit back down at the table, and then begin to yell loudly with no specific content. The staff indicated that Bill would briefly stop yelling while sitting at the table if the staff sat and talked with him. However, Bill would resume yelling after a short period of time. The staff further commented, “You know, it would not be so bad if he didn’t always have these fits when I am busy preparing meals.”

Mr. Hewlet suspected that the timing of Bill’s target behaviors might have something to do with the function of the behavior. He asked if the behavior happened at any time other than right before meals. A staff person replied, “Oh yes, sometimes it happens when I am preparing the snacks.” Further questioning revealed that the behavior happened only around times when food was provided and that the yelling and tantrum behaviors stopped as soon as Bill accessed food. One of the staff did indicate that sometimes she would provide him with a little bit of food prior to meals “to take the edge off.” She could then get back to preparing the meal for everyone in the house. She indicated that she did not like to do this, but sometimes it was the only way to get him to stop long enough for her to prepare the meal. Mr. Hewlet now knew that the target behaviors at least intermittently accessed a tangible item and were more likely at times when Bill was likely to have been food deprived (hungry). He was sure that the behaviors served a SMA function. Mr. Hewlet asked if Bill ever engaged in the target behaviors when no other people were around. The staff indicated the target behaviors occurred only around the staff and only at meal and snack times. There was no difference in his target behaviors regardless of which of the staff were working, and the behavior occurred when staff were interacting with him and when they were not. This latter piece of information seemed to rule out a target behavior diagnosis of SMA 2.1: Staff Attention. There was no difference in his target behaviors if peers were present or not, which would tentatively rule out SMA 2.2: Peer Attention. With this information, Mr. Hewlet was reasonably sure that the behavioral diagnosis would be SMA 2.3: Tangible Reinforcer, food item (see Table 5.1).

Mr. Hewlet asked the staff if they had ever seen Bill prepare his own food. The staff replied “No, we do all that for him.” Further questioning indicated that there were no house rules that prohibited clients from preparing their own food. Mr. Hewlet decided that in this case, perhaps it would be most effective to simply teach Bill to prepare his own food item when he was hungry. He found out from the staff that Bill’s favorite food was a peanut butter and jelly sandwich. However, no one knew if Bill had the skill to prepare a sandwich for himself. Mr. Hewlet set up a simple trigger analysis to find out what skill Bill had in making his own sandwich.

Mr. Hewlet placed all the needed materials for making a peanut butter and jelly sandwich on the counter in the kitchen. At the same time staff were preparing a snack, Mr. Hewlet said “Bill, come over here and make yourself a peanut butter and jelly sandwich.” He then gestured to the sandwich-making items. Bill stopped walking, looked at Mr. Hewlet and then at the peanut butter jar, smiled, and proceeded to the kitchen. Mr. Hewlet observed Bill’s efforts at sandwich making and was pleasantly surprised to find out that Bill not only was

TABLE 5.1 n YELLING OR TANTRUM DIAGNOSTIC TABLE

Diagnosis SMA 2.3: Tangible Reinforcer, Food Item

Target behavior(s): Yelling/tantrums

Function: Access food item

Target behavior likely under following contexts: Waiting for meals and snacks

Target behavior unlikely under following contexts: While eating and immediately after eating

Rule out: SMA 2.1: Staff Attention SMA 2.2: Peer Attention

SMA, socially mediated access.

190 Functional Behavioral Assessment, Diagnosis, and Treatment

quite fluent in sandwich making but also cleaned up after himself! Mr. Hewlet repeated these trigger analysis trials on five more occasions with the same result (see Example Form 5.2).

If Bill had not been able to complete the task, Mr. Hewlet would have completed a Task Analysis and developed a plan to teach him the skill using a combination of Discrete Trial Training, Incidental Teaching, Chaining, and Behavioral Fluency. Mr. Hewlet now could develop a simple contingency plan that he knew would eliminate the tantrums and yelling. This plan would enable the alternative replacement behavior, while disabling the target behavior.

Based on the trigger analysis, Mr. Hewlet developed the following contingency. If Bill tantrums or yells loudly, he will not be provided food of any kind until the target behaviors have been absent for 2 minutes. If he prepares his own sandwich, he is free to eat it. He is to have free access to the sandwich-making materials 30 minutes before snacks and meals. Staff will continue taking data on tantrums and yelling and also record if he has prepared and consumed any food independent of staff (see Example Form 5.3).

The plan was implemented and was very effective, as can be seen on the completed Example Form 5.1B data sheet. The function of the target behavior of tantruming or yelling was quickly disabled, and the function of the DA behavior of making and eating a sandwich was enabled and maintained by the naturally occurring environmental contingencies.

What If?

What if the person refuses or is unable to complete the DA behavior?

This would require teaching the person the skill first. If the person was unable to acquire the skill, then some environmental set up would be needed to allow the person a way to access the reinforcer directly. If that were still not possible, an alternative might be to use NCR.

What if the DA behavior results in the person getting the reinforcer at too high a rate?

If this occurs, the simplest solution would be to implement a Premack contingency. In using a Premack contingency, the person could still directly access the reinforcer, but the complexity

Example Form 5.1B n Simple Frequency Data

• Client: Bill Chart Started: ______________

Day/Month/Year

• Target Behavior: Tantrums/yelling

• DA Replacement Behavior: Making and eating a sandwich

• Number of Days: 6

• Place an X on the appropriate day box each time the behavior occurs

• Total occurrences observed: 3

• Total occurrences observed: 35

1 2 3 4 5 6 7 Totals

DA behavior xxx xxxxx xxxxxx xxxxx xxxxxx xxxxxx xxxx

Daily rate 3 5 6 5 6 6 4 35

1 2 3 4 5 6 7 Totals

Target behavior

xx x

Daily rate 2 1 0 0 0 0 0 3

5 Functional Behavioral Treatment Protocols for SMA 2.0: Target Behaviors 191

Example Form 5.2 n Trigger Analysis Trial Data

• Client name: Bill

• Antecedent set up: ______________

• Motivation for the reinforcing item will be assured by: Doing trigger analysis 30 minutes before a meal

• Availability of the reinforcing item will be indicated by: A verbal prompt and the sandwich-making items being out on the counter

• Type and sequence of prompts to be used: Verbal, then gestural, then graduated guidance if needed

• Preferred response: Prepares and eats a peanut butter and jelly sandwich with no assistance and cleans up afterwards

• Conditions regarding access to the reinforcing item:

l° How much: One Sandwich l° How long: N/A

• I = Independent P = prompted N = did not complete

• Independent completion rate: Whole task (completed/possible): 0/6

• Prompted completion rate: Whole task (completed/possible): 6/6

• Time to complete task:

l° Longest 10 min l° Shortest 2 min l° Average 5.33 min

Step Description

1 Initiates sandwich making

2 Gets bread

3 Opens peanut butter and jelly

4 Gets knife and spreads peanut butter and jelly

5 Assembles sandwich

6 Cleans area

7 Consumes sandwich

Trial Date Time Start

Time End

Step % Comp

1 2 3 4 5 6 7

1 11:30 11:40 P I I I I I I 86%

2 4:30 4:35 P I I I I I I 86%

3 4:30 4:36 P I I I I I I 86%

4 11:30 11:35 P I I I I I I 86%

5 11:30 11:32 P I I I I I I 86%

6 11:30 11:34 P I I I I I I 86%

192 Functional Behavioral Assessment, Diagnosis, and Treatment

or duration of the behavior required prior to access could be increased. This would require more effort on the part of the client to access the reinforcer and thereby reduce the frequency of access.

What if the person can do the DA behavior, but is too slow?

If the person is simply taking too long to complete the task, you should consider fluency training or differential reinforcement of higher rates of behavior (DRH). In fluency training, the focus is on breaking the task down into the individual movements required to complete each step of the overall task, and then increasing the speed of movement of each component rather than focusing on accurate performance of the entire task. Accuracy of the entire task develops as each component can be performed quickly, accurately, and without hesitation.

DRH focuses on differentially reinforcing the person performing the behavior faster. The faster the person does the behavior, the greater the pay off. Both methods are effective at speeding up slow performances.

Forms: DA

5.1: Simple Frequency Data with Rate Formulas 5.2 DA: Trigger Analysis Trial Data Sheet 5.3 DA: Simple Plan

Example Form 5.3 n DA: Simple Plan

• Person served: Bill

• Target behavior: Yelling and tantrums

• Behavioral diagnostic category: SMA 2.3: Tangible Reinforcer, food item.

• DA behavior: Making own sandwich

• Designated time period(s): Any

• Rate of target behavior Baseline: 4.6 per day Target: 0

• Rate of DA behavior Baseline: 0 Target: 3 per day

• Initial form or task analysis of DA behavior: Assemble and consume a peanut butter and jelly sandwich with the items already available on the kitchen counter.

• Reinforcing item/event to be directly accessed: Food items

• When and how will it be made available: Initially all items to assemble a sandwich will be left out on the kitchen counter and will be made available to Bill 30 minutes before each snack and meal.

• How to respond to the target behavior: Remove all food items until Bill has stopped engaging in the target behaviors for 2 minutes. Then prompt Bill to the kitchen area where the sandwich-making items are located. Prompt him to assemble a sandwich if he does not independently do so.

• How to build the DA replacement behavior: Prompt Bill to the kitchen area where the sandwich-making items are located. Prompt him to assemble a sandwich if he does not independently do so.

• Types of prompts to be used:

☒ Visual ☒ Vocal □ Written ☒ Touch □ Graduated Guidance

• When to use prompts: Visual prompt in the form of items used to prepare sandwich should be out at all times; vocal prompt to make a sandwich should be given if Bill is walking toward the table around meal times; a touch prompt should be used to direct Bill to the area of the sandwich-making materials if the verbal prompt was ineffective.

5 Functional Behavioral Treatment Protocols for SMA 2.0: Target Behaviors 193

Form 5.1 n Simple Frequency Data with Rate Formulas

• Client: _________________________ Chart Started: _____________________

Day/Month/Year

• Behavior: ________________________________________________________ __________________________________

• Total Observation Time: min (__, ___-minute session/day) Session Length: min

• Number of Days: __

• Place an X on the appropriate day box each time the behavior occurs

A. Total minutes observed: __

B. Total occurrences observed: __ Rate/minute = B/A / = ____

C. Range (low) __ to (high) __, Avg = __ Rate/hour = (B/A)60 ( / )60 = ____

A. Total minutes observed: __

B. Total occurrences observed: __ Rate/minute = B/A / = ____

C. Range (low) __ to (high) __, Avg = __ Rate/hour = (B/A)60 ( / )60 = ____

1 2 3 4 5 6 7 Totals

Target behavior

Daily rate

8 9 10 11 12 13 14 Totals

DA behavior

Daily rate

194 Functional Behavioral Assessment, Diagnosis, and Treatment

Form 5.2 n DA Trigger Analysis Trial Data Sheet

• Client name:

• Antecedent set up:

• Motivation for the reinforcing item will be ensured by:

• Availability of the reinforcing item will be indicated by:

Type and sequence of prompts to be used:

• Preferred response:

• Conditions regarding access to the reinforcing item:

l° How much:

l° How long:

• I = Independent P = prompted N = did not complete

• Independent completion rate: Whole task (completed/possible): /

• Prompted completion rate: Whole task (completed/possible): /

• Time to complete task:

l° Longest _______

l° Shortest ______

l° Average ______

Step Description 1

2

3

4 5 6 7

Date Time Start

Time End

Step % Comp

Trials 1 2 3 4 5 6 7

1

2

3

4

5

6

5 Functional Behavioral Treatment Protocols for SMA 2.0: Target Behaviors 195

Form 5.3 n DA: Simple Plan

• Person served: ____________________________________________________ ________________________________________________________________

• Target behavior: ___________________________________________________ ________________________________________________________________

• Behavioral diagnostic category: ________________________________________ ________________________________________________________________

• DA behavior: _____________________________________________________ ________________________________________________________________

• Designated time period(s): ___________________________________________ ________________________________________________________________

• Rate of target behavior Baseline: __________ Target: __________

• Rate of DA behavior Baseline: __________ Target: __________

• Initial form or task analysis of DA behavior: ________________________________ ________________________________________________________________ _______________________________________________________________ ________________________________________________________________

• Reinforcing item/event to be directly accessed: _____________________________ ________________________________________________________________ _______________________________________________________________ ________________________________________________________________

• When and how will it be made available: _________________________________ ________________________________________________________________ _______________________________________________________________ ________________________________________________________________

• How to respond to the target behavior: ___________________________________ ________________________________________________________________ _______________________________________________________________ ________________________________________________________________

• Types of prompts to be used:

• □ Visual □ Vocal □ Written □ Touch □ Graduated Guidance

• When to use prompts: _______________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________

ADDITIONAL RESOURCES Dattilo, J., & Camarata, S. (1991). Facilitating conversation through self-initiated augmentative communication treatment. Journal of Applied Behavior Analysis, 24, 369–378. Mithaug, D. K., & Mithaug, D. E. (2003). Effects of teacher-directed versus student-directed instruction on self-management of young children with disabilities. Journal of Applied Behavior Analysis, 36, 133–136. Thompson, R. H., & Iwata, B. A. (2000). Response acquisition under direct and indirect contingencies of reinforcement. Journal of Applied Behavior Analysis, 33, 1–11.

196 Functional Behavioral Assessment, Diagnosis, and Treatment

Vaughn, B. J., & Horner, R. H. (1997). Identifying instructional tasks that occasion problem behaviors and assessing the effects of student versus teacher choice among these tasks. Journal of Applied Behavior Analysis, 30, 299–312.

SMA FUNCTIONS: DRL GROUP CONTINGENCIES FOR PEER ATTENTION Brief Description One cannot often successfully instruct peers to ignore the target problem behavior of a particular peer so that the targeted person will behave more appropriately. It is necessary to implement a group contingency that results in the group’s reinforcement being contingent upon the lowering of the rate of the target behavior for the group as a whole. This option involves providing a reinforcer to a group of students or clients for achieving a group criterion. The reinforcer is presented following a specified period of time during which the identified target behavior for the entire group occurs at or below a prespecified level (termed the behavioral standard).

In this SMA option, reinforcement is provided to the entire group only when the rate of a target behavior for the whole group, during a specified period of time, is lower than a prescribed limit, for example, the class cannot have more than five disruptive incidents in the morning in order to earn 10 minutes of extra recess after lunch. By using a group contingency, we establish the motivation for the peer group to ignore the person engaged in target behaviors. Once the group meets the initial behavioral standard, we systematically change the standard over time to shape the rate of target behavior to a final criteria level. This allows for more frequent contact with the reinforcing event initially and generally speeds the learning process.

To implement a group DRL program, determine what level of the target behavior is acceptable for the group as a whole (behavioral standard). Next, measure the target behavior across the entire group during a specified interval of time. The group’s frequency of occurrence of the target behavior is compared with the behavioral standard. If the group’s frequency of behavior is above the standard, reinforcement is withheld. If the group’s frequency is at or below the behavioral standard, reinforcement is provided to the group.

The advantage of using a DRL procedure is that it is relatively easy to implement, and it specifically focuses on the reduction but not total elimination of the target behavior. It is not designed to teach any new behavior but alters the rate or intensity of already existing behaviors. The disadvantage with any group contingency is that it may also result in inappropriate forms of counter control by peers toward a targeted individual.

Terms DRL interval: The length of time during which the group must maintain the occurrence of

the target behavior below the behavioral standard to earn the group reinforcer. Behavioral standard: The level of behavior that is considered acceptable. This is set as a

function of baseline data on the group’s rate of behavior. Changing criterion: The process of systematically changing the behavioral standard to

successively lower rates that approximate the final criteria. Final criteria: The terminal behavioral standard. This is the goal. When reached, it will

indicate that the DRL has been a success and no further reduction in target behaviors is warranted.

5 Functional Behavioral Treatment Protocols for SMA 2.0: Target Behaviors 197

Apparatus Timing device—This can be a kitchen timer, alarm clock, computer with alarm feature, Palm

Pilot, tape recorder with beeps at designated intervals, or a calendar, depending on the length of the schedule of reinforcement. The purpose is to prompt the staff person, teacher, or parent to provide the reinforcer.

Data sheets—See Form 5.5, “Simple Frequency Data on Group and Individual Behaviors.” Reinforcing items or events—If tangible items will be utilized, a sufficient supply must be

available.

Baseline Measurement 1. Determine that the target behavior is maintained by peer reinforcement (i.e., SMA

2.2: Peer Reinforcement). 2. Operationally define or pinpoint the target behavior being observed, with specific

criteria for onset and offset of behavior (if not readily evident). 3. Determine the observation period possibly by reviewing scatter plot or A-B-C

data to identify periods of time when the target behavior is highly likely or at the specific time of day or event in which you would like to reduce the level of the target behavior.

4. Construct the data sheet to reflect the length of the observation period, trying to keep the length reasonably similar across multiple sessions (see Form 5.4).

5. During observation, record the occurrence of the target behavior for the whole group (if desired use special notation for specific individuals of interest).

6. Repeat step 5 until the observation period ends. 7. Sum the total number of occurrences for the entire group, and enter on the data

sheet. 8. Collect this data for at least five more baseline sessions, and graph the data.

DRL Procedures 1. Determine the final criteria for the behavioral standard for the group, as well as for

the individual client or student. 2. From baseline data, calculate the mean level of occurrence for the group. 3. Determine your initial behavioral standard and DRL interval. (The initial standard

and interval should be equivalent to baseline levels.) 4. Set the timing device to the initial interval. 5. When the designated time period elapses, deliver the designated reinforcer to the

group if the group’s behavior did not exceed the behavioral standard. 6. If the group’s frequency of the target behavior exceeds the behavioral standard, do not

provide the reinforcer. 7. As occurrences decrease, gradually change the criterion of the behavioral standard

until you reach the final criteria.

Changing the Criterion The behavior analyst can change the behavioral standard in a stepwise fashion such that it is closer to the final criteria as a function of client performance. A good general rule is to change the behavioral standard by 10% at each step, when the designated criterion level of performance is met.

198 Functional Behavioral Assessment, Diagnosis, and Treatment

How It Works The group contingency DRL removes peer reinforcement for the child or client’s target behavior. This is accomplished by tying the group’s access to tangible reinforcers to a lowered rate or intensity of target behavior. The social environment enabled the target behavior of the individual by frequently providing the desired peer attention contingent upon its occurrence. The DRL schedule disables this function by providing reinforcement to the group only if the target behavior occurs relatively infrequently (i.e., below a preset standard). Peers will be less likely to provide attention when the individual engages in the target behavior because the individual’s frequency of target behavior now partly determines reinforcement rate and magnitude for the whole group. Peer reinforcement for the target behavior is consequently removed. It is possible that such peer reinforcement might shift to other behaviors not directly targeted. This can be remedied by including the new behaviors in the DRL contingency.

Hypothetical Example

Class Clown

Billy is a junior high school special education student. He engages in frequent, verbally inappropriate behavior toward teachers. Subsequent to such behavior the class laughs, girls smile, boys nod their head, and all have a good time. He has peers wanting to hang out with him during recess and at lunch. When Billy is “disciplined” by being sent to the principal’s office, it actually increases the attention he gets from his peers.

Mrs. Jones, the principal, after constantly seeing Billy in her office for referrals, discusses the case with Billy’s teacher, Mr. Smith, who is in his first year of teaching. Mrs. Jones believes Billy does these behaviors for teacher attention. She advises him to ignore students when they do things like this or he will continue to have problems managing his classroom.

Teacher

Mr. Smith returned to his classroom. He decided to try out the principal’s advice and ignore Billy’s silly behaviors in the hopes that such behaviors would stop. Mr. Smith considered the specific examples of Billy’s behavior that were inappropriate so that he could pinpoint a definition of the behavior. He identified the following behaviors as components of the target behavior:

1. Low volume statements that were audible to the class but not the teacher 2. Facial and hand gestures not related to answering academic questions 3. Comments that resulted in other students attending to Billy rather than classroom

instructions 4. Direct verbal refusals to complete academic tasks

With this definition, Mr. Smith took baseline data for 1 week. He did this by simply counting the frequency of verbally inappropriate behavior (as he had defined it). Mr. Smith also decided to keep a frequency count of the same behaviors across the rest of the class. The data he collected are presented in Table 5.2.

TABLE 5.2 n VERBAL INAPPROPRIATE BEHAVIOR

Day Class Billy Total Class Total Billy

1 xxxxxxxxxxxxxxx xxxxxx 15 6

2 xxxxxxxxxxxx xxxxxxxx 12 8

3 xxxxxxxxxxxxx xxxxxxx 13 7

4 xxxxxxxxx xxxxxxxxxx 9 10

5 xxxxxxxxxxxxx xxxxxxxxxxxxx 13 13

5 Functional Behavioral Treatment Protocols for SMA 2.0: Target Behaviors 199

Mr. Smith reviewed the data and considered what might be maintaining Billy’s behavior. He noticed that the behavior occurred when there were task demands as well as during free time. Mr. Smith concluded that it probably was not an escape-maintained behavior. He noticed that the behavior never resulted in Billy getting an item such as food or a book, so it was not maintained by access to a tangible item.

He decided that he would ignore Billy’s inappropriate verbal behavior and instead attend to Billy only when he was participating in class. He decided to apply this same contingency to the class as a whole for 1 week, and he obtained the data presented in Table 5.3.

Mr. Smith was pleasantly surprised at the effect his attention had on most of the class. He also noticed that his attention had no apparent effect on Billy’s behavior. He could now safely rule out a diagnosis of SMA 2.1: Adult Attention. A more fitting diagnosis for Billy’s behavior was SMA 2.2: Peer Attention (see Table 5.4).

Great! But now what? How do you change the behavior of the whole class? How can one make Billy’s peers responsible for not “feeding into” this behavior? Mr. Smith decided that he would definitely need to set up a group contingency to address this problem’s function in getting peer attention. A group contingency would tie everyone’s “lot” together. Either everyone earns the reinforcer, or no one earns it!

Mr. Smith’s class was a very social group. Given a choice of activities, they would certainly choose to have time to talk in class with each other. He decided to set up the following group contingency. The class would earn extra peer conversation time at the end of the period if the class stayed below a certain level of inappropriate verbal comments. Mr. Smith developed the following plan (see Example Form 5.4).

TABLE 5.3 n INAPPROPRIATE VERBAL BEHAVIOR (EXTINCTION TRIAL)

Day Class Billy Total Class Total Billy

1 xxxxxxx xxxxxxxxx 7 9

2 xxxxx xxxxxxxx 5 8

3 xxxxxx xxxxxxxxx 6 9

4 xxxxx xxxxxxxxxxx 5 11

5 xxxxxxx xxxxxxxxxxx 7 11

TABLE 5.4 n VERBALLY INAPPROPRIATE BEHAVIOR TOWARD TEACHERS DIAGNOSTIC TABLE

Diagnosis SMA 2.2: Peer Attention

Target behavior(s) Verbally inappropriate behavior toward teachers

Function Access peer attention

Target behavior likely under following contexts

Peers present in structured setting with teacher

Target behavior unlikely under following contexts

Individual meetings with teacher; no peers present

Rule out SMA 2.1 Adult Attention Socially mediated escape

SMA, socially mediated access.

200 Functional Behavioral Assessment, Diagnosis, and Treatment

Example Form 5.4 n Group Contingency DRL: Simple Plan

• Group: 3rd period class

• Individual (if any): Billy

• Target behavior: Verbally inappropriate behavior

• Replacement behavior: On-task verbal responses

• Designated time period for contingency: Entire class period

• Baseline data (sessions or days): 5 days

• Initial behavioral standard: 15 or fewer events of verbally inappropriate behaviors.

• Criteria for adjusting standard up: 5 consecutive class periods meeting the behavioral standard will result in a reduction of allowed verbally inappropriate behaviors by 1 statement per class period.

• Criteria for adjusting standard down: 5 consecutive class periods not meeting the standard. New standard will be set at the mean level of occurrence for the whole class including Billy’s data.

• Reinforcement to be delivered: 10 minutes of free time for conversations at the end of the class period.

Day/session Group Individual Total group Total Individual

1 xxxxxxx xxxxxxxxx 7 9

2 xxxxx xxxxxxxx 5 8

3 xxxxxx xxxxxxxxx 6 9

4 xxxxx xxxxxxxxxxx 5 11

5 xxxxxxx xxxxxxxxxxx 7 11

Mean Frequency 6 9.6

Mr. Smith implemented the plan by explaining to the class that he would be counting the number of verbally inappropriate behaviors. He gave examples of such behaviors to the class. He let the class know that if they could stay below the behavioral standard, they would earn 10 minutes of free time at the end of the class period. He also let them know that he would be the only and final authority in regard to their score with respect to the standard.

Additionally, any event of bullying or threatening any of their classmates would result in the immediate loss of the 10 minutes of free time. He then led a brief discussion on how each person in the class might help to meet the behavioral standard.

Mr. Smith continued recording data as listed in Example Form 5.5. In reviewing the data, Mr. Smith noted that initially the class reduced their verbally

inappropriate behavior, but Billy’s actually increased to an average of about 12 times per day. Billy’s rate of target behavior appeared to have peaked at 16 incidents on day 4 and declined rapidly on the following 4 days. Mr. Smith attributed this increase to an extinction burst. He surmised that this occurred because the rest of the class no longer attended to Billy when he made inappropriate statements. By the 9th day of the intervention,  the  class had met the criterion to increase the behavioral standard, so Mr. Smith changed the standard to 14 or fewer events of verbally inappropriate behavior. The class continued to meet the standard, and Mr. Smith continued to change the standard as they progressed.

5 Functional Behavioral Treatment Protocols for SMA 2.0: Target Behaviors 201

Example Form 5.5 n Simple Frequency Data on Group and Individual Behaviors

• Student: Billy Chart Started: ___________________

• Group: 3rd period Day/Month/Year

• Behavior: Verbally Inappropriate behavior

• Session Length: 90 min

• Number of Days: 21

• Place an X on the appropriate day box each time the behavior occurs

1 2 3 4 5 6 7 Totals

Group 6 5 2 2 1 1 1 18

Client 9 11 14 16 14 11 12 87

8 9 10 11 12 13 14 Totals

Group 2 3 2 2 2 2 2 15

Client 9 8 6 4 4 3 2 36

15 16 17 18 19 20 21 Totals

Group 1 2 1 2 1 2 1 10

Client 2 1 1 1 1 1 2 9

What If?

What if the behavior does not decrease (or gets worse) with the group contingency DRL?

As in the example, there may be a brief increase as the client adjusts to the new contingencies. If you have diagnosed the function correctly, it should decrease within a few sessions or days. If it persists longer than this, consider a more intensive assessment as you may have misdiagnosed the function of the behavior. Consider also that it may be a multiple function behavior and that the initial diagnosis was simply incomplete in that it diagnosed only one function.

What if the group becomes abusive to one of the group members?

This can be an issue in using group contingencies. One can set up an additional criterion as Mr. Smith did. If an abusive incident occurs even once, it results in an immediate loss of the reinforcing item or event. If you have a group that tends to be abusive to each other, you might also consider a group contingency relative to increasing socially appropriate interactions as your first step. After that is successful, consider targeting verbally inappropriate behavior.

202 Functional Behavioral Assessment, Diagnosis, and Treatment

Form 5.4 n Group Contingency DRL: Simple Plan

• Group: __________________________________________________________

• Individual (if any): __________________________________________________

• Target behavior: ___________________________________________________

• Replacement behavior: ______________________________________________

• Designated time period for contingency: __________________________________

• Baseline data (sessions or days): _______________________________________

• Initial behavioral standard: ___________________________________________ ________________________________________________________________

• Criteria for adjusting standard up: _______________________________________ ________________________________________________________________

• Criteria for adjusting standard down: ____________________________________ ________________________________________________________________

• Reinforcement to be delivered: _________________________________________ ________________________________________________________________

Day/session Group Individual Total Group Total Individual

1

2

3

4

5

Mean Frequency

Forms: Differential Reinforcement of Other Behaviors With Extinction

5.4 Group Contingency DRL: Simple Plan 5.5 Simple Frequency Data on Group and Individual Behaviors

5 Functional Behavioral Treatment Protocols for SMA 2.0: Target Behaviors 203

7 8 9 10 12 13 14 Totals

Group

Client

1 2 3 4 5 6 7 Totals

Group

Client

15 16 17 18 19 20 21 Totals

Group

Client

22 23 24 25 26 27 28 Totals

Group

Client

29 30 31 1 2 3 4 Totals

Group

Client

Form 5.5 n Simple Frequency Data on Group and Individual Behaviors

• Client: _________________ Chart Started: ________________

• Group: _________________ Day/Month/Year

• Behavior: ________________________________________________________

• Session Length: __min

• Number of Days: __

• Place an X on the appropriate day box each time the behavior occurs

204 Functional Behavioral Assessment, Diagnosis, and Treatment

ADDITIONAL RESOURCES Cipani, E. (2004). Classroom management for all teachers: 12 plans for evidence-based practice (2nd ed.). Upper Saddle River, NJ: Pearson. Dietz, S. M., & Repp, A. C. (1973). Decreasing classroom misbehavior through the use of DRL schedules of reinforcement. Journal of Applied Behavior Analysis, 6, 457–463. Deitz, S. M., & Repp, A. C. (1974). Differentially reinforcing low rates of misbehavior with normal elementary school children. Journal of Applied Behavior Analysis, 7, 622. doi: 10.1901/jaba.1974.7-622 Lennox, D. B., Miltenberger, R. G., & Donnelly, D. R. (1987). Response interruption and DRL for the reduction of rapid eating. Journal of Applied Behavior Analysis, 20, 279–284. Singh, N. N., Dawson, M. J., & Manning, P. (1981). Effects of spaced responding DRL on the stereotyped behavior of profoundly retarded persons. Journal of Applied Behavior Analysis, 14, 521–526. Wright, C. S., & Vollmer, T. R. (2002). Evaluation of a treatment package to reduce rapid eating. Journal of Applied Behavior Analysis, 35, 89–93.

SMA FUNCTIONS: OMISSION TRAINING (DIFFERENTIAL REINFORCEMENT OF OTHER BEHAVIOR, OR DRO) Brief Description In differential reinforcement of other behavior, or DRO, the specific maintaining reinforcer is contingent on the absence of the target behavior in a given period of time. DRO is one of the simplest of all behavior reduction procedures. One could view a DRO as a reinforcement system that allows the person to earn specific reinforcement by engaging in a host of varying behaviors as long as the target unacceptable behavior does not occur.

To implement a DRO program, you would determine if the target behavior occurred during a specified interval of time. If it occurred, reinforcement is withheld, and the interval (called the DRO interval) is reset for the full length of time. If the target behavior did not occur during the DRO interval, specific reinforcement (i.e., the functional reinforcer) is provided at the end of the DRO interval. By structuring the contingencies in this way, engaging in any behavior other than the targeted behavior pays off better. Concurrently, the target behavior’s functional relation to reinforcement is disabled.

The advantage of using a DRO procedure is that it is easy to implement and specifically focuses on the reduction of the unwanted behavior. It is not designed to teach any new behavior or to target any specific behavior for an increase. The advantages generally outweigh the disadvantages with this procedure. It has been one of the most widely used reductive procedures for unwanted behaviors.

Terms Interbehavior interval: The length of time that passes between the end of one targeted behavior

and the beginning of the next occurrence of the targeted behavior. DRO interval: The length of time for which the person must abstain from engaging in the

target behavior in order to earn the reinforcer. Thinning the schedule of delivery of maintaining reinforcer: The process of gradually reducing

the delivery of the reinforcer so that more time elapses between each delivery.

Apparatus Timing device—This can be a kitchen timer, alarm clock, computer with alarm feature, and

so on, a tape recorder with beeps at designated intervals, or a calendar, depending on the length of the schedule of reinforcement. The purpose is to prompt the staff person, teacher, or parent to provide the reinforcer when the DRO interval elapses.

5 Functional Behavioral Treatment Protocols for SMA 2.0: Target Behaviors 205

Data sheets—See Form 5.6 “Simple Frequency Data With Formulas.” Reinforcing items or events—If tangible items or activities have been identified as the

maintaining reinforcers and will be delivered on a DRO schedule, a sufficient supply must be available.

Baseline Measurement 1. Identify the target behavior to be observed and its function. 2. Operationally define or pinpoint the behavior being observed, with specific criteria

for onset and offset of behavior (if not readily evident). 3. Determine the observation period, possibly by reviewing scatter plot or A-B-C

data to identify periods of time when the target problem behavior is highly likely.

4. Construct the data sheet to reflect the length of the observation period, trying to keep the length reasonably similar in multiple baseline sessions.

5. During the observation period, record any occurrence of the target behavior. 6. Sum the occurrences across the session, and enter them on the data sheet. 7. Divide the session length by the total frequency of target behavior (see following

examples) to arrive at the interbehavior interval for that session. 8. Continue observing client and target behavior for at least four more baseline

sessions. 9. Graph or display the interbehavior interval across all baseline sessions noting the

range and mean.

Calculating the Interbehavior Interval

Table 5.5 contains data on the frequency of hitting (target behavior) for a hypothetical client. All observation sessions were 120 minutes in length. The observations were conducted over 5 days.

Using the data from Table 5.5 to calculate the interbehavior interval for the entire 5 days of observation, we would simply take the total number of minutes we conducted observations and divide that number by the total number of occurrences of the target behavior. In this case:

600 total minutes ÷ 18 total occurrences of behavior = an interbehavior interval of 33.33 minutes

If we were to calculate the interbehavior interval for day 1 it would be:

120 minutes ÷ 2 occurrences of behavior = an interbehavior interval of 60 minutes

If we were to calculate the interbehavior interval for day 5 it would be:

120 minutes ÷ 6 occurrences of behavior = an interbehavior interval of 20 minutes

TABLE 5.5 n FREQUENCY OF HITTING AND INTERBEHAVIOR INTERVALS

1 2 3 4 5 Totals

Hitting xx xxx xxxxx xx xxxxxx 18

Interbehavior interval

60 min 40 min 24 min 60 min 20 min 33.33 min

206 Functional Behavioral Assessment, Diagnosis, and Treatment

DRO With Extinction Procedures 1. From your baseline data, calculate the interbehavior interval. 2. Determine your schedule of delivery of the maintaining reinforcer. (The initial

schedule should be set so that reinforcement occurs at or more frequently than the average interbehavior interval, e.g., initial interval set at 20% below the average interbehavior interval. Mean interbehavior interval of 300 seconds would yield an initial schedule of reinforcement that occurred every 240 seconds.)

3. Obtain a supply of the tangible reinforcer to be delivered (if dealing with SMA 2.3: Tangible Reinforcer).

4. Set the timing device to the initial delivery schedule. 5. When the timer goes off, deliver the reinforcer to the person if the person has not

engaged in the target behavior for the entire time prior to the timer going off, and then reset the timer.

6. If the client engages in the target behavior during the interval, do not provide the reinforcer, but rather reset the timer for the full DRO interval (extinction).

7. Thin the schedule of reinforcement.

Thinning the Schedule of Delivery of Maintaining Reinforcer

The schedule of reinforcement is thinned when the target behavior goal is achieved. When the goal is achieved, the behavior analyst can increase the length of the DRO interval and set a new target behavior goal. The steps for thinning the schedule follow.

1. When the target behavior goal is achieved, increase the length of the interval between reinforcement by 5% to 10%. For example, if the DRO interval was 5 minutes, and the target behavior goal was met, then the new schedule for delivery might be set at 5 minutes, 30 seconds.

2. With each week of success in achieving the target behavior goal, the schedule of delivery is thinned by progressively increasing the DRO interval by 10%.

3. If the target behavior occurs at a rate higher than the goal consistently over a given week, consider returning to the previous schedule of reinforcement. (If you have made several attempts at thinning the schedule but are unable to get past a particular DRO interval, it may be best to keep the schedule at that level while incorporating another functional behavior treatment option.)

If utilizing this behavior option for DA behaviors: Utilize the same baseline and treatment procedures as above, except that chain interruption would occur instead of extinction when the target behavior is displayed.

How It Works The DRO, or omission training, works as a result of altering the schedule of delivery of an identified maintaining reinforcer in favor of behaviors other than the target behavior (see Borrero & Vollmer, 2002, regarding Matching Law). Previously, the exhibition of the target behavior was functional. The social environment enabled the function of the target behavior by frequently providing the desired positive reinforcer contingent upon its occurrence. The DRO schedule disables this function by further postponing the delivery of the reinforcer with an occurrence of the target behavior, that is, the interval is reset. Therefore, doing anything other than the target behavior is a more efficient path to accessing the reinforcer.

5 Functional Behavioral Treatment Protocols for SMA 2.0: Target Behaviors 207

Hypothetical Example

Milton the Pincher

Milton was a person diagnosed with schizophrenia who had developed the behavior of frequently pinched other clients. Mrs. Symthe, a staff member on the unit, believed that Milton pinched other clients as the result of his schizophrenia. She claimed that he has an inability to control his impulses, and therefore, behavioral intervention efforts will not prove fruitful. Mr. Delgadillo, the behavioral consultant, believed differently. He was determined to identify the maintaining reinforcer of the pinching and produce an intervention that addressed such a function.

Mr. Delgadillo started by interviewing the inpatient staff members. He asked the following questions:

1. What was he doing, or what was going on before he engaged in the pinching? 2. What did he specifically do? What did the pinching look like? 3. What happened after he pinched? What did staff do? How did they react?

Unfortunately, the answers that staff provided did not point clearly to the function of the pinching behavior. Some staff reported that Milton pinched when he was left alone, some reported that he pinched when it was noisy, and other staff reported that Milton pinched when asked to complete a task. They were all relatively consistent in reporting how the pinching behavior looked (form or topography), so Mr. Delgadillo was reasonably certain they were all observing and reporting on the same behavior. In regard to what happened after the pinching behavior, again the answers were quite varied. One staff person indicated that pinching got Milton out of doing certain tasks. Another indicated that she thought Milton pinched so that he could “be the center of attention.” Because no clear antecedent conditions and no clear function could be determined from the interviews, Mr. Delgadillo decided to set up an A-B-C chart for him and the staff to collect data during a 2-week period. Table 5.6 is a representative sample of such data.

Mr. Delgadillo examined the A-B-C descriptive data in Table 5.6 and then set about answering the question: What are the common elements in all five events involving pinching? While some of the incidents involved a demand placed on Milton, other situations did not involve any demands (see incidents 2 and 5). It did not appear that pinching was functioning to escape demands. However, to test whether escape from a task or taking a walk with staff was the function of pinching, Mr. Delgadillo set up a simple test. He took Milton for a walk, and then arranged for the doctor to evaluate Milton immediately upon their return. The evaluation by the doctor was chosen as it had been one of the demand situations during which Milton had engaged in pinching. Milton did not pinch and in fact was very cooperative with the doctor’s assessment. Mr. Delgadillo repeated this test using several different task demands. Each time he replicated this test, he obtained the same result. When Milton was given a walk a priori, he handled the subsequent task demands with no problem. Mr. Delgadillo was now fairly certain that Milton’s behavior served a SMA function. But was it attention or tangible contingencies that maintained the pinching behavior?

Mr. Delgadillo reviewed the data and found that the pinching behavior did not subside when staff were talking with Milton. Further, Milton was observed to have excellent social skills in that he was very adept at starting and maintaining conversations with both staff and peers. From this information, Mr. Delgadillo ruled out SMA 2.1: Staff Attention and SMA 2.2: Peer Attention.

Mr. Delgadillo had previously noted that in all five cases he observed, the eventual outcome was that Milton went for a walk outside of the unit with a staff person. Mr. Delgadillo determined the most likely hypothesis is that pinching is being maintained by SMA to a tangible reinforcer, in this case, going for a walk (SMA 2.3: Tangible Reinforcer, walking outside the unit).

208 Functional Behavioral Assessment, Diagnosis, and Treatment

TABLE 5.6 n A-B-C OBSERVATION SUMMARY OF PINCHING BEHAVIOR

Antecedent Conditions Target Behavior

What Happened? What Was Natural Result of Behavior?

1. Sitting in the art therapy room and asked to paint.

Pinched peer. Separated and counseled and taken outside for a walk at his request.

Sensation produced when pinching someone else’s skin.

2. Watching TV in the day room. Finally settled down after perseverating on going outside all morning. The public defender came to talk to another client.

Pinched visitor. Separated, counseled, and taken outside to walk and relax.

Sensation produced when pinching someone else’s skin.

3. Short of staff, more noisy than usual. He asked to go for a walk and was told that we could not go today.

Pinched his preferred staff.

Nonpreferred staff immediately took him out of the building to walk until he “seemed calm.”

Sensation produced when pinching someone else’s skin.

4. During psychiatrist rounds, Milton perseverated on going for a walk with staff. Doctor asking him about how he was doing.

Pinched doctor 3 times, last one very hard.

Restrained, then taken for a walk to help him calm down before seeing the doctor again.

Sensation produced when pinching someone else’s skin.

5. Sitting in the dayroom playing cards with his preferred staff. Another client became agitated, and staff were attempting to prompt the other client to go outside for a walk.

Smiled and began pinching his staff repeatedly, unresponsive to redirection to stop pinching.

Another staff person prompted him to use his calming strategy and go for a walk with the staff person. He waved at his preferred staff, continued smiling, and went out for a walk.

Sensation produced when pinching someone else’s skin.

Why would staff engage in such a response to pinching? The staff response made sense to them at the time, in that they judged Milton to be in a state of anxiety, particularly when around other clients. They would therefore take him out for a walk to calm him down. While on the walk, Milton appeared calmer, and he stopped pinching. Facility staff thereby interpreted their use of a walk as an anxiety reductive procedure and believed this practice was clinically sound.

However, Mr. Delgadillo’s assessment led to an alternate hypothesis. Milton’s pinching (of other people) is a functional behavior when he desires a walk. The exhibition of such a behavior greatly increases the chances that staff will take him out. Unfortunately other more appropriate behaviors did not appear to be as effective in getting a walk (see Table 5.7).

5 Functional Behavioral Treatment Protocols for SMA 2.0: Target Behaviors 209

Having formulated a diagnosis of pinching as SMA 2.3: Tangible Reinforcer in the form of a walk, Mr. Delgadillo procured a summary of the unit’s reliable data on the occurrence of target behaviors, including times and dates of occurrence. Data was collected over a 4-hour session (240 minutes) each day. Unit records indicated that Milton was pinching people about three times per hour (see Example Form 5.6).

The interbehavior interval was calculated by determining the

Total Minutes Observed (1200 minutes) ÷ Total Frequency target behavior occurred (58 occurrences) = average interbehavior interval (20.7 minutes)

TABLE 5.7 n PINCHING STAFF DIAGNOSTIC TABLE

Diagnosis SMA 2.3: Tangible Reinforcer

Target behavior(s): Pinches staff

Function: Accesses walk with staff (walk is the driving force because he cannot go on a walk outside unless accompanied by staff)

Target behavior likely under following contexts: When he has been without a walk for an entire day

Target behavior unlikely under following contexts:

When he is taken for a walk early in the afternoon

Rule out: Socially mediated escape function (SME 4.1) and socially mediated access function (SMA 2.1 and 2.2)

Example Form 5.6 n Frequency Count Data Sheet

• Client: _________________________ Chart Started: 6/21

Day/Month/Year

• Behavior: Pinching

• Total Observation Time: 1200 min (1,240-minute session/day)

• Session Length: 240 min

• Number of Days: 5

A. Total minutes observed: 1,200 Interbehavior interval = A/B 1,200/58 = 20.69 min Rate/hour = (B/A)60 (58/1,200)60 = 2.9/hr

1 2 3 4 5 Totals Pinching xxxxxxx xxxxxxxxxxx xxxxxxx

xxxxxx xxxxxxxx xxxxxxxx

xxxxxxxxxxx 58

Daily rate 1.75/hr 2.75/hr 3.25/hr 4/hr 2.75/hr 2.9/hr

Interbehavior interval

34.29 min 21.82 min 18.46 min 15 min 21.82 min 20.69 min

210 Functional Behavioral Assessment, Diagnosis, and Treatment

Example Form 5.7 n Differential Reinforcement Plan

• Person served: Milton

• Target behavior: Pinching

• Behavioral diagnostic category: SMA 2.3: Tangible Reinforcer

• Target rate: 0 events per week

• Designated time period(s): 8:00 a.m.to 12:00 noon

• Baseline data across five times/sessions: 1. 7

2. 11

3. 13

4. 16

5. 11

• Rate of target behavior Baseline: 2.9/hour Target: 0

• Interbehavior interval Baseline: 20.7 min Target: 24 hours

• Initial schedule of differential reinforcement:

X Fixed time schedule every 15 minutes

OR

Variable time schedule on average every minutes/hours/days

• Reinforcer(s) to be used: 1. Walk outside with staff 2. ____________________ 3. ____________________ 4. ____________________ 5. ____________________

• Reset timer: End of each interval

X End of each interval AND if target behavior occurs

Special instructions for delivery of reinforcer(s):

If pinching occurs, immediately reset the timer to 15 minutes and record data.

• Criterion for increasing amount of time between reinforcers: When pinching behavior occurs in <1% of intervals observed for three consecutive days, increase time DRO interval by 10%.

• Criterion for decreasing the amount of time between reinforcers: If pinching behavior occurs in more than 5% of observed intervals for three consecutive days, decrease DRO interval by 1 minute.

• Criterion for withholding the scheduled reinforcer delivery: Occurrence of pinching.

With this data in hand, and an understanding of the function of the pinching behavior, Mr. Delgadillo formulated an intervention plan (see Example Form 5.7). Having determined that the pinching behavior occurred about every 20 minutes, he set the initial DRO interval to 15 minutes to ensure that Milton was very likely to obtain reinforcement in the form of outside walks more often under this plan.

Prior to implementing the program, Mr. Delgadillo informed the staff that an extinction burst would probably occur and that they should be prepared for this event. He also made sure to be on the unit during the implementation of the program so that

5 Functional Behavioral Treatment Protocols for SMA 2.0: Target Behaviors 211

60

Frequency of Pinching Per Day

50 Frequency of Pinching

40

Fr eq

ue nc

y o

f p

in ch

in g

30

Days

20

10

0 6/25 7/137/127/117/107/97/87/77/67/57/47/37/27/16/306/296/286/276/26 7/14

70

FIGURE 5.1 n Frequency of pinching behavior.

he could help to support the staff and to assure them that the program was implemented correctly. The program was implemented, and the data was collected and is presented in Figure 5.1.

As Mr. Delgadillo expected, and as can be seen in Figure 5.1, the DRO was successful in reducing the occurrence of pinching behavior. It is interesting to note that as Mr. Delgadillo predicted, on 6/26 the pinching behavior worsened. This is a familiar and expected pattern when using extinction. It is called an extinction burst. Following this burst (increase in rate from prior level) the pinching behavior steadily and quickly declined. Because Mr. Delgadillo had let the staff know what to expect, they were prepared for this and stuck with the plan. By 7/14 the behavior had met the criteria for thinning the DRO schedule, so Mr. Delgadillo increased the interbehavior interval by 10% such that reinforcement was now delivered every 17 minutes. Mr. Delgadillo continued this thinning process until the pinching behavior was no longer occurring and Milton was going on walks with a staff person once in every 24-hour period.

What If?

What if the behavior does not decrease (or gets worse) with DRO?

When using DRO with extinction, an initial worsening of the target behavior is very possible. The technical term for this is an extinction burst. As the name implies, it is a brief and often intense increase in the target behavior. Such a result is often the case when the target behavior no longer produces the maintaining reinforcer. However, one should see a dramatic decrease in the target behavior within 3 sessions or days. If the behavior continues at a high rate for longer than that, you will need to confirm that the item or event you are using is actually reinforcing for the person (i.e., is the functional reinforcer). The other possibility is that the DRO interval is simply too long for the person to contact the reinforcer at a high enough rate to enable the nonoccurrence of target behaviors as functional. In this case, shortening the DRO interval is an option you should consider. If this is still ineffective, you should consider starting with NCR.

212 Functional Behavioral Assessment, Diagnosis, and Treatment

Form 5.6 n Simple Frequency Data with Formulas

• Client:_________________________ Chart Started:_______________

Day/Month/Year

• Behavior: ________________________________________________________ _____________________________________

• Total Observation Time: min (_____, ____-minute session/day) Session Length: min

• Number of Days: ____

• Place an X on the appropriate day box each time the target behavior occurs

A. Total minutes observed:____ Interbehavior interval = A/B / = ____

• Rate/hour = (B/A)60 ( / )60 =_____

A. Total minutes observed: Interbehavior interval = A/B / = ____

B. Total Occurrences Observed: Rate/minute = B/A / = ____

C. Range (low) __ to (high) __, Avg = __ Rate/hour = (B/A)60 ( / )60 =_____

1 2 3 4 5 6 7 Totals

Target behavior

Daily rate

Interbehavior interval

What if I cannot ignore some of the target behaviors?

If the target behavior has life-threatening consequences and cannot be ignored, you can program a DRO without extinction. In this case, all the elements of the DRO would be the same with the exception that, when the target behavior occurs, we will continue to respond to it as we have in the past. This will make the behavior change process somewhat slower because the difference in level of reinforcement will not be as great. This can be countered to some extent by shortening the DRO interval, thus increasing the density of reinforcement for all other behaviors.

Forms: Differential Reinforcement of Other Behaviors With Extinction

5.6 Simple Frequency Data With Formulas 5.7 Differential Reinforcement of Other Behavior With Extinction: Simple Plan 5.8 Formulas for Calculating Rate of Targeted Behavior and Interbehavior Interval 5.9 Formulas for Determining Increases or Decreases in Frequency of Differential

Reinforcement

8 9 10 11 12 13 14 Totals

Target behavior

Daily rate

Interbehavior interval

5 Functional Behavioral Treatment Protocols for SMA 2.0: Target Behaviors 213

Form 5.7 n Differential Reinforcement of Other Behavior with Extinction: Simple Plan

• Person served:

• Target behavior:

• Behavioral diagnostic category:

• Target rate:

• Designated time period(s):

• Baseline data across five times/sessions: 1. ________________

2. ________________

3. ________________

4. ________________

5. ________________

• Rate of target behavior Baseline: Target:

• Interbehavior interval Baseline: Target:

• Initial schedule of differential reinforcement:

l° ____Fixed time schedule every ____ minutes/hours/days

OR

l° ____Variable time schedule on average every ____ minutes/hours/days

• Reset timer:

l° ____End of each interval

l° ____End of each interval AND if target behavior occurs

• Reinforcer(s) to be used: 1. ________________

2. ________________

3. ________________

4. ________________

5. ________________

l° Special instructions for delivery of reinforcer(s):

• Criterion for increasing amount of time between reinforcers:

• Criterion for decreasing amount of time between reinforcers:

• Criterion for withholding the scheduled reinforcer delivery:

214 Functional Behavioral Assessment, Diagnosis, and Treatment

ADDITIONAL RESOURCES Barton, L. E., Brulle, A. R., & Repp, A. C. (1986). Maintenance of therapeutic change by momentary DRO. Journal of Applied Behavior Analysis, 19, 277–282. Borrero, J. C., & Vollmer, T. R. (2002). An application of the matching law to severe problem behavior. Journal of Applied Behavior Analysis, 35, 13–27. Carole C., Miltenberger, R., Maki, A., Barenz, R., Jurgens, M., Sailer, A., . . . Kopp, B. (2004). A comparison of response cost and differential reinforcement of other behavior to reduce disruptive behavior in a preschool classroom. Journal of Applied Behavior Analysis, 37, 411–415. Cowdery, G. E., Iwata, B. A., & Pace, G. M. (1990). Effects and side effects of DRO as treatment for self-injurious behavior. Journal of Applied Behavior Analysis, 23, 497–506. Goetz, E. M., Holmberg, M. C., & LeBlanc, J. M. (1975). Differential reinforcement of other behavior and noncontingent reinforcement as control procedures during the modification of a preschooler’s compliance. Journal of Applied Behavior Analysis, 8, 77–82.

Form 5.9 n Formulas for Determining Increases or Decreases in Frequency of Differential Reinforcement

• Formula for 10% increase in time between reinforcement.

Current reinforcement interval × 1.10 = (10% increase in time)

• Formula for 5% increase in time between reinforcement.

Current reinforcement interval × 1.05 = (5% increase in time)

• Formula for 10% decrease in time between reinforcement.

Current reinforcement interval × 0.90 = (10% decrease in time)

• Formula for 5% decrease in time between reinforcement.

Current reinforcement interval × 0.95 = (5% decrease in time)

Form 5.8 n Formulas for Calculating Percentage of Intervals of Targeted Behavior and Interbehavior Interval

• Interbehavior interval: This formula will help you determine on average how much time passes between the occurrence of targeted behaviors (Interbehavior interval). Use this information to help set the frequency of NCR.

l° Total minutes observed ÷ Total behavior occurrences observed = Average interbehavior interval

• Rate: This formula will help you determine how often the behavior occurs in a given amount of time. Use this formula if you have different lengths of observation periods to allow for ongoing comparison of data.

l° Number of occurrences of behavior ÷ Length of observation in minutes = Rate of behavior per minute

l° Rate per hour = (rate per minute) 60 l° Rate per day = (rate per minute) 1,440

5 Functional Behavioral Treatment Protocols for SMA 2.0: Target Behaviors 215

Haring, T. G., & Kennedy, C. H. (1990). Contextual control of problem behavior in students with severe disabilities. Journal of Applied Behavior Analysis, 23, 235–243. Harris, S. L., & Wolchik, S. A. (1979). Suppression of self-stimulation: Three alternative strategies. Journal of Applied Behavior Analysis, 12, 185–198. Heard, K., & Watson, T. S. (1999). Reducing wandering by persons with dementia using differential reinforcement. Journal of Applied Behavior Analysis, 32, 381–384 Lindberg, J. S., Iwata, B. A., Kahng, S., & DeLeon, I. G. (1999). DRO contingencies: An analysis of variable-momentary schedules. Journal of Applied Behavior Analysis, 32, 123–136. Luce, S. C., Delquadri, J., & Hall, R. V. (1980). Contingent exercise: A mild but powerful procedure for suppressing inappropriate verbal and aggressive behavior. Journal of Applied Behavior Analysis, 13, 583–594. Marcus, B. A., & Vollmer, T. R. (1996). Combining noncontingent reinforcement and differential reinforcement schedules as treatment for aberrant behavior. Journal of Applied Behavior Analysis, 29, 43–51. Martinez, S. S. (1977). Comparison of extinction, DRO 0-sec, and DRO 6-sec in the elimination of imitative responding under discrete-trial paradigms. Journal of Applied Behavior Analysis, 10, 315. Mazaleski, J. L., Iwata, B. A., Vollmer, T. R., Zarcone, J. R., & Smith, R. G. (1993). Analysis of the reinforcement and extinction components in DRO contingencies with self-injury. Journal of Applied Behavior Analysis, 26, 143–156. McCord, B. E., Iwata, B. A., Galensky, T. L., Ellingson, S. A., & Thomson, R. J. (2001). Functional analysis and treatment of problem behavior evoked by noise. Journal of Applied Behavior Analysis, 34, 447–462. Piazza, C. C., Fisher, W. W., Hanley, G. P., Hilker, K., & Derby, K. M. (1996). A preliminary procedure for predicting the positive and negative effects of reinforcement-based procedures. Journal of Applied Behavior Analysis, 29, 137–152. Repp, A. C., Barton, L. E., & Brulle, A. R. (1983). A comparison of two procedures for programming the differential reinforcement of other behaviors. Journal of Applied Behavior Analysis, 16, 435–445. Repp, A. C., & Deitz, S. M. (1974). Reducing aggressive and self-injurious behavior of institutionalized retarded children through reinforcement of other behaviors. Journal of Applied Behavior Analysis, 7, 313–325. Rolider, A., & Van Houten, R. (1985). Movement suppression time-out for undesirable behavior in psychotic and severely developmentally delayed children. Journal of Applied Behavior Analysis, 18, 275–288. Thompson, R. H., Iwata, B. A., Hanley, G. P., Dozier, C. L., & Samaha, A. L. (2003). The effects of extinction, noncontingent reinforcement, and differential reinforcement of other behavior as control procedures. Journal of Applied Behavior Analysis, 36, 221–238. Vollmer, T. R. (1999). Noncontingent reinforcement: Some additional comments. Journal of Applied Behavior Analysis, 32, 239–240. Vollmer, T. R., Iwata, B. A., Zarcone, J. R., Smith, R. G., & Mazaleski, J. L. (1993). The role of attention in the treatment of attention-maintained self-injurious behavior: Noncontingent reinforcement and differential reinforcement of other behavior. Journal of Applied Behavior Analysis, 26, 9–21. Woods, D. W., & Himle, M. B. (2004). Creating tic suppression: Comparing the effects of verbal instruction to differential reinforcement. Journal of Applied Behavior Analysis, 37, 417–420.

216 Functional Behavioral Assessment, Diagnosis, and Treatment

SMA FUNCTIONS: NONCONTINGENT REINFORCEMENT (NCR) WITH EXTINCTION Brief Description In NCR, the specific maintaining reinforcer is presented noncontingently following a given period of time. Reinforcement is provided even if the behavior has or is occur- ring. The NCR plan reduces the rate of behavior by reducing the client’s motivation to access the reinforcer. Hence, the motivation to engage in a behavior that produces such a reinforcer is also altered. This method is similar to methods termed response independent reinforcement or time-based delivery of stimuli with known reinforcing properties (Vollmer, 1999).

In NCR with extinction, the specific maintaining reinforcer is presented following a given period of time. There is one caveat to this time-based delivery. The reinforcer is withheld if the person is engaging in the target behavior at the time of the scheduled delivery. It is provided once the target behavior ceases. To implement this option for SMA problem behaviors, you need to determine how frequently to provide the reinforcer. You deliver the reinforcing item based on that time schedule, unless the target behavior is occurring at a scheduled delivery. If the target behavior is currently occurring, you would withhold the reinforcer until the target behavior had subsided for some brief period of time.

The advantage of using an NCR procedure is that it is easy to implement and quickly alters the target behavior by reducing the client’s deprived condition relative to the reinforcer. NCR procedures generally do not teach or strengthen any new replacement functions. They alter the rate of the target behavior by simply removing the motivation underlying the targeted behavior. Generally, NCR will be used in conjunction with other replacement function options that are designed to teach specific replacement functions. NCR may not be useful in situations where frequent access to the maintaining reinforcer is impractical or not feasible.

Terms Schedule of reinforcer delivery: This refers to the interval schedule of noncontingent delivery

for the maintaining reinforcer to be made available to the client or child. Interbehavior interval: The length of time that passes between the end of one targeted

behavior and the beginning of the next occurrence of the targeted behavior. Thinning schedule of delivery of maintaining reinforcer: The process of gradually reducing the

delivery of the reinforcer so that more time elapses between each delivery. Partial interval method of recording: An interval recording strategy that involves observing

whether a behavior occurs or does not occur during specified time periods. Partial interval recording requires the observer to record the occurrence of the behavior (in the respective interval) if it occurs in any part of the interval. If a behavior occurs several times within an interval, it is recorded as occurring only once within that interval. If a behavior occurs for a long period of time, it is recorded during each interval in which  it occurred, even if it was for only for part of a given interval. For example, a person may bang his or her head 10 times in one interval but only once in another interval. Both intervals will be marked to indicate that the behavior occurred, despite the difference in the number of head bangs that occurred in both intervals. The illustration in Table 5.8 indicates the partial interval recording in the top row (designated by an X) with the actual frequency presented in the bottom row.

Table 5.9 is another example of a partial interval recording system with a behavior that is of long duration. Let us say a client’s target behavior is yelling. The client is observed to initiate yelling in the middle of interval 1. He or she finally stopped in the middle of interval 3. In the partial interval system, yelling behavior would be recorded as occurring in intervals 1, 2, and 3.

5 Functional Behavioral Treatment Protocols for SMA 2.0: Target Behaviors 217

TABLE 5.8 n PARTIAL INTERVAL DATA

Interval 1 2 3 4 5 6 7 8 9 10

What you would record X X X X X X

Actual frequency of behavior 0 1 5 0 2 1 5 0 0 1

TABLE 5.9 n PARTIAL INTERVAL DATA LONG DURATION

Interval 1 2 3 4 5 6 7 8 9 10

What you would record

X X X

Actual duration

l-----------------------l

Apparatus Timing device—This can be a kitchen timer, alarm clock, computer with alarm feature, tape

recorder with beeps at designated intervals, or a calendar, depending on the length of the schedule of NCR. Its purpose is to prompt the staff person, teacher, or parent to provide the reinforcer.

Data sheets—See Form 5.10 “Partial Interval Data, 30-Minute Intervals,” and Form 5.11 “Partial Interval Data, 2-Minute Intervals”

Reinforcing items or events—If tangible items or activities that have been identified as the maintaining reinforcers are to be delivered on a NCR with extinction schedule, a sufficient supply must be available.

Baseline Measurement Baseline measurement consists of determining the interbehavior interval for the target behavior. To accomplish this, a partial interval method is used for recording the occurrence of the target behavior. Partial interval methods of recording are useful when dealing with behaviors that may be difficult to keep track of or when staff persons have many other duties besides collecting data.

Steps to Collect Baseline Data Using Partial Interval Recording

1. Identify the target behavior to be observed. 2. Operationally define or pinpoint the behavior being observed. 3. Determine the observation period, possibly reviewing scatter plot or A-B-C data to

identify periods of time when behavior is highly likely. 4. Determine the length of the observation period and divide the observation period

into equal interval blocks (keeping these the same across baseline sessions). 5. Construct the data sheet. 6. During observation, enter date and time of day on data sheet and set timing device

for interval length.

218 Functional Behavioral Assessment, Diagnosis, and Treatment

7. At the end of each interval, if the target behavior occurred at all, place an X in the corresponding interval on the data sheet.

8. Repeat step 7 until the observation period ends. 9. Sum the total number of intervals in which a target behavior occurred, and enter that

number on the data sheet. 10. Continue observing client and target behavior for at least four more baseline sessions.

For example, the staff person records partial interval data on the rate of occurrence of the targeted behavior on the following data sheet. Observations are made five times per day, for 10 minutes. If the behavior occurs within a given 2-minute interval, an X is placed on that respective interval. Therefore, the following data sheet for 1 day of observation reveals a grid, involving five intervals per observation across five observation sessions.

Example of Partial n Interval Data

• Recording Method: Partial interval

• Interval Length: 2 minutes

• Client: Arthur Chart Started: 2/1

Day/Month/Year

• Behavior: XXX

• Total Observation Time: 50 min (1, 10-minute session/day) Session Length: 10 min

• Number of Days: 5

• □ Behavior did NOT occur ☒ Behavior DID occur

Day of the month/Start time

• Grand total = 16 intervals with target behavior over a possible 25 intervals

• Interbehavior interval = 50 min/16 intervals with behavior = 3.125 minutes

Interval # Day 1 10:30

Day 2 12:10

Day 3 1:10

Day 4 2:15

Day 5 2:45

1 X X X X

2 X X X X

3 X X

4 X X

5 X X X X

Total 2 4 3 4 3

Recording Method: Partial Interval

As you can see, in the first observation period (column marked Day 1), the client engaged in the target behavior only during the second and fourth intervals during the entire 10-minute observation. During the next observation period, the client engaged in the target behavior in intervals 1, 2, 3, and 5. The totals at the bottom of each column are out of a possible 5 intervals that the behavior can be recorded. Summing across the row labeled “Total” yields 16 intervals in which the target behavior was recorded as having occurred (against a total of 25 intervals for 5 days of observation). With this ratio 16/25, one can compute the percentage of occurrence, in this case 64% of intervals.

5 Functional Behavioral Treatment Protocols for SMA 2.0: Target Behaviors 219

The interbehavior interval can also be calculated by dividing the number of minutes of observation for the week (50) by the number of intervals that the target behavior occurred (16), which yields an average interbehavior interval of 3.125 minutes. In other words, the target behavior occurs about every 3 minutes. In this example, it is important to note that the rate of target behavior is relatively stable across the five observation periods. If it were more varied, one should examine what factors were different at each observation to account for the variability in rate of occurrence.

NCR With Extinction Procedures 1. From baseline data, calculate the interbehavior interval. 2. Determine your schedule of delivery of the maintaining reinforcer. (The initial

schedule should be set so that reinforcement occurs at or more frequently than the shortest interbehavior interval, e.g., initial interval set at 80% of the average interbehavior interval.)

3. Obtain a supply of the reinforcer to be delivered. 4. Set the timing device to the initial delivery schedule. 5. When the timer goes off, deliver the reinforcer to the person if the person has not

engaged in the target behavior for 5 to 10 seconds prior to the timer going off. 6. Reset the timer. 7. If the client has engaged in the target behavior prior to the timer going off, then

withhold the reinforcing item until the target behavior stops for 10 seconds (extinction).

8. Record data on data sheet. 9. Thin the schedule of reinforcement.

Thinning the Schedule of Delivery of Maintaining Reinforcer

The schedule is thinned when the target behavior goal is achieved. When the goal is achieved, increase the length of the interbehavior interval and set a new target behavior goal. The steps for thinning the schedule follow.

1. When the target behavior goal is achieved with the program, increase the length of the interval between deliveries by 5% to 10%. For example, if the length of time between noncontingent delivery was 5 minutes and the target behavior goal was met, the new schedule for delivery might be set at 5 minutes, 30 seconds.

2. With each week of success in achieving the target behavior goal, the schedule of delivery is increased progressively by 10%.

3. If the target behavior occurs at a rate higher than the target behavior goal consistently over a given week, consider returning to the previous schedule of reinforcement.

4. If you have made several attempts at thinning the schedule but are unable to get past a particular rate of reinforcement, it may be best to keep the schedule at that level while incorporating another functional treatment program.

If utilizing this behavior option for DA behaviors: Utilize the same baseline and treatment procedures as above, except that chain interruption would occur instead of extinction when the target behavior is displayed.

How It Works 1. By eliminating the client’s motivation for a particular reinforcing item or event. When

there is no motivation for the item or event, there is no reason for the person to do any of the behaviors that previously produced that reinforcer.

220 Functional Behavioral Assessment, Diagnosis, and Treatment

2. By disrupting the learned contingency between the client’s unwanted target behavior and the reinforcing event. That is, the reinforcing event happens on some time schedule and is withheld if the unwanted behavior occurs, so the person may learn that the unwanted behavior is no longer needed to get the reinforcer.

Hypothetical Example

Mr. K, a behavioral consultant, was asked to help find a way to reduce the amount of aggressive behavior exhibited on the playground by a kindergarten student named Kim. The teacher and playground supervisor felt that Kim engaged in such behavior because she was immature for her age and her parents “spoiled her at home.” Mr. K. began the consultation by operationally defining the behaviors. The target behaviors were defined as: using any body part to make physical contact with any body part of another person with sufficient force to be judged as intentional. Examples included hitting, biting, and kicking other children. What would not be counted as aggression was incidental contact from the play activity, such as bumping into someone, falling on someone during running, and so forth.

Baseline data was collected, and a functional assessment was completed by observing Kim on the playground as well as collecting A-B-C data. This data was used to perform a descriptive analysis of the various forms of Kim’s aggressive behavior. The following data from one observation period on 6/21 reflects the contextual data surrounding Kim’s aggressive behavior on the playground. Because the hypothesis was a socially mediated event, the last column is marked inconsequential (see Table 5.10).

From the A-B-C data in Table 5.10, it was determined that Kim’s aggressive behavior was maintained by SMA to staff attention (SMA 2.1: Adult Attention). In this case, one of the teacher’s volunteer aides, Ms. State, was inadvertently maintaining this behavior (see Table 5.11).

If Kim went longer than 4 to 8 minutes without “playing” with any of the other children during recess, she would hit, bite, and kick other students close to her to get Ms. State to stop playing with other children and come to the area. In some cases, she would remove Kim and spend time counseling her on how to interact with other students. The desired event appears to be the aide’s prompting of play with the other children and simultaneously playing with Kim in the process.

TABLE 5.10 n SUMMARY OF A-B-C OBSERVATIONS PHYSICAL AGGRESSION

Antecedent Conditions

Target Behavior

What Did Aide Do? What Was Natural Result of Behavior?

11:40 By self, not interacting with others.

Hit peer. Aide came over and told her to apologize and “play nice.”

Inconsequential.

11:51 on the periphery of an activity with several other children.

Kicked another child.

Aide took Kim aside and explained why it is important to cooperate with other children, then they played a game together with other children, with aide providing lots of praise for Kim.

Inconsequential.

5 Functional Behavioral Treatment Protocols for SMA 2.0: Target Behaviors 221

TABLE 5.11n PHYSICAL AGGRESSION DIAGNOSTIC TABLE

Diagnosis SMA 2.1: Adult Attention

Target behavior(s): Physical aggression

Function: Access adult attention

Target behavior likely under following contexts: Anytime Kim goes longer than 8 minutes without playing with another student

Target behavior unlikely under following contexts:

While interacting with the teacher’s aide, Ms. State

Rule out: SMA 2.2: Peer Attention SME 4.1: Unpleasant Social Situations

SMA, socially mediated access; SME, socially mediated escape.

Example Form 5.11A n Partial Interval Data

• Condition: Baseline

• Recording Method: Partial interval

• Interval Length: 2 minutes

• Client: Kim Chart Started: 7/5

Day/Month/Year

• Behavior: Physical aggression

• Total Observation Time: 100 min Session length: 20 min

□ Behavior did NOT occur ☒ Behavior DID occur

Day of the month

Interval # Interval end time 7/5 7/6 7/7 7/8 7/9

1 2 X X

2 4 X X

3 6 X X

4 8 X X

5 10 X

6 12 x X X

7 14

8 16 X X X

9 18 X X X

10 20

Total 2 3 4 4 5

Mr. K. needed an adequate analysis of the rate of this behavior during playground periods. He collected baseline data from the 5th through the 9th of the following month. Example Form 5.11A illustrates the recording of the behavior in 2-minute intervals with a partial interval recording system.

222 Functional Behavioral Assessment, Diagnosis, and Treatment

In graphing the data from Form 5.11, it appeared that there was an increasing trend in the occurrence of the unwanted behavior (2, 3, 4, and 5 intervals on consecutive days; see Figure 5.2).

Mr. K. could have calculated the interbehavior interval on the cumulated data, and it would have looked like this:

100 minutes ÷18 intervals with aggression = 5.56 Minutes

In order to increase the likelihood of getting a positive effect quickly, Mr. K. calculated the interbehavior interval based on the session with the most occurrences, thus ensuring that the rate of NCR was higher than the rate of reinforcement she was currently receiving for aggressive behaviors.

Mr. K. counted the total number of minutes of the observation (20) and divided it by the total number of intervals in which aggression occurred (5). This gave him an average interbehavior interval of 4 minutes.

20 minutes ÷ 5 intervals with aggression = 4 minutes

Mr. K. decided to start with an NCR schedule that required the aide to prompt and help Kim play with the other children on a set schedule, hopefully prior to her engaging in aggression (see Example Form 5.12).

Mr. K. then started the intervention on the 12th of the month. The data are presented in Example Form 5.11B.

We can present the same data in graphical format to more easily see the trends (see Figure 5.3).

Based on the data that no aggression had occurred for 3 consecutive days, Mr. K. changed the schedule to 1 minute of social interaction every 3.5 minutes.

3 minutes (current schedule) × 1.10 (10% increase) = 3.3 minutes

(Note: Because the time frames were relatively short, and Mr. K. knew that his timing device would make it difficult to track anything smaller than half a minute, he rounded up to 3.5 minutes.)

60 Kim Aggression Baseline

50

Baseline

40

% o

f in

te rv

al s

in w

hi ch

a g

g re

ss io

n o

cc ur

re d

30

Days

20

10

0 7/6 7/7 7/8 7/97/5

FIGURE 5.2 n Aggressive behavior.

5 Functional Behavioral Treatment Protocols for SMA 2.0: Target Behaviors 223

Example Form 5.11B n Partial Interval Data

• Condition: Baseline

• Recording Method: Partial interval

• Interval Length: 2 minutes

• Client: Kim Chart Started: 7/12

Day/Month/Year

• Behavior: Physical aggression

• Total Observation Time: 100 min Session Length: 20 min

□ Behavior did NOT occur ☒ Behavior DID occur

Day of the month

Interval # Interval end time

7/12 7/13 7/14 7/15 7/16 7/17 7/18 7/19 7/20 7/21 7/22 7/23 7/24

1 2 2 4 X 3 6 X X 4 8 5 10 X 6 12 7 14 8 16 9 18 10 20

Total 3 0 0 0 1 0 0 0 0 0 0 0 0

60 Kim Partial Interval Aggression

50 Baseline NCR

40

% o

f in

te rv

al s

in w

hi ch

a g

g re

ss io

n o

cc ur

re d

30

20

10

0

Days

7/5 7/237/227/217/207/197/187/177/167/157/147/137/127/117/107/97/87/77/6 7/24

FIGURE 5.3 n Partial interval aggression data.

224 Functional Behavioral Assessment, Diagnosis, and Treatment

Example Form 5.12 n NCR With Extinction: Simple Plan

• Person served: Kim

• Target behavior: Physical aggression

• Target behavior goal: Aggression in less than 1% of observed intervals

• Designated time period(s): Lunch playground period 25 minutes per day

• Baseline data across five times/sessions: 1. 2 2. 3 3. 4 4. 4 5. 4

• % of intervals in which target behavior occurred: Baseline 40% Target <1%

• % of intervals in which reinforcement occurred: Baseline ________ Target _______

• Interbehavior interval: Baseline 40 min Target 15 min

• Initial schedule of noncontingent reinforcement:

l° X Fixed time schedule every 3 minutes and at the outset of the playground activity.

OR

l° ____Variable time schedule on average every _____ minutes/hours/days

• Reinforcer(s) to be used: 1. Prompting of play behavior with other children by Ms. State, Ms. State to interact for 1 min

2. ________________

3. ________________

4. ________________

5. ________________

l° Special instructions for delivery of reinforcer(s): Ms. State is primary deliverer of prompt and social interaction. If she is not available, it may be done by another person. The other person should have some interactions with Kim prior to the playground period.

• Criterion for increasing amount of time between reinforcers: When aggressive behavior occurs in <1% of intervals observed for 3 consecutive days, increase time between delivery of NCR by 10%.

• Criterion for decreasing the amount of time between reinforcers: If aggressive behavior occurs in more than 5% of observed intervals for 3 consecutive days, decrease time between delivery of NCR by 1 minute.

• Criterion for (extinction) withholding scheduled reinforcer delivery: If aggressive behavior has occurred within 5 seconds of the scheduled delivery of reinforcement or is currently occurring, do not provide the reinforcer until the aggressive behavior has stopped for 30 seconds.

There was one event of aggression on the first day of the new schedule but no further occurrences for 3 days after that. Mr. K. continued this process until the schedule had been thinned to every 10 minutes. After consultation with the teacher and teacher’s aide as to the

5 Functional Behavioral Treatment Protocols for SMA 2.0: Target Behaviors 225

feasibility, Mr. K. decided to keep the NCR schedule at this level while they taught Kim some new behaviors that she could use to request the teacher’s aide to provide social interaction. Kim continued to have no events of physical aggression during the acquisition of a simple request for attention, in this case “Please play with me.”

It was noted that Kim could make the request quite well during training but was not using it during recess. Mr. K. surmised that the NCR that was keeping the aggression from occurring did so by eliminating the motivation to do any behavior that functioned to  produce adult attention. He therefore began thinning the schedule of NCR 10% following every 3 consecutive days with less than 1% intervals having an occurrence of aggression.

Upon reducing the noncontingent delivery of reinforcement, Kim began to use the requesting behavior she had previously learned. Mr. K. continued to collect data and thin the schedule of NCR until the targeted interbehavior interval of 15 minutes.

Mr. K. then discontinued the NCR delivery but continued to take data for 1 month to ensure that the new behavior would continue to be effective in obtaining social attention.

What If?

What if the behavior does not decrease (or gets worse) with NCR?

This may happen, although it is less likely with this program than with others. When the target behavior is no longer effective in obtaining the desired reinforcer, it may occur more frequently (called an extinction burst). If it occurs during NCR, it is possible the schedule of delivery is not dense enough. Try shortening the time between reinforcer delivery. If there is still no effect, it is very likely that your functional assessment was incorrect and that there is a different reinforcer maintaining the unwanted behavior. It would be best to return to taking A-B-C data and repeat the functional assessment. You may also try making a wider variety of potentially reinforcing items available while you repeat the functional assessment.

What if I cannot ignore some of the target behaviors?

In cases where the target behavior is very serious or life threatening, it is best to start with much shorter schedules. A general guideline would be to set the initial schedule to 20% of the interbehavior interval. With very serious behaviors, you should consider starting with a continuous presentation of the reinforcer until replacement functions can be developed. Of course, it is imperative that you also have an emergency plan to ensure the safety of all the people involved in the intervention.

Forms: Noncontingent Reinforcement With Extinction

5.10 Partial Interval Data, 30-Minute Intervals 5.11 Partial Interval Data, 2-Minute Intervals 5.12 Noncontingent Reinforcement With Extinction: Simple Plan 5.13 Formulas for Calculating Percentage of Intervals of Targeted Behavior and

Interbehavior Interval 5.14 Formulas for Determining Increases or Decreases in Frequency of Noncontingent

Reinforcement

226 Functional Behavioral Assessment, Diagnosis, and Treatment

Form 5.10 n Partial Interval Data, 30-Minute Intervals

• Condition: Treatment Recording Method: Partial interval

• Client: Chart Started: ______________

Day/Month/Year

• Behavior: ______________________________

• Interval Length: 30 minutes Total Observation Time: __ Session Length: __

□ Behavior did NOT occur ☒ Behavior DID occur

Day of the month/start time

Interval # Interval end time

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

1 6:30 a.m.

2 7:00 a.m.

3 7:30 a.m.

4 8:00 a.m.

5 8:30 a.m.

6 9:00 a.m.

7 9:30 a.m.

8 10:00 a.m.

9 10:30 a.m.

10 11:00 a.m.

11 11:30 a.m.

12 12:00 p.m.

13 12:30 p.m.

14 1:00 p.m.

15 1:30 p.m.

16 2:00 p.m.

17 2:30 p.m.

18 3:00 p.m.

19 3:30 p.m.

20 4:00 p.m.

21 4:30 p.m.

22 5:00 p.m.

23 5:30 p.m.

24 6:00 p.m.

25 6:30 p.m.

26 7:00 p.m.

27 7:30 p.m.

28 8:00 p.m.

29 8:30 p.m.

30 9:00 p.m.

31 9:30 p.m.

32 10:00 p.m.

5 Functional Behavioral Treatment Protocols for SMA 2.0: Target Behaviors 227

Form 5.11 n Partial Interval Data, 2-Minute Intervals

• Condition: Treatment Recording Method: Partial interval

• Client: Chart Started: ______________

Day/Month/Year

• Behavior:

• Interval Length: 2 minutes Total Observation Time: __ Session Length: __

□ Behavior did NOT occur ☒ Behavior DID occur

Day of the month/start time

Interval # Interval length

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

1 2 2 4 3 6 4 8 5 10 6 12 7 14 8 16 9 20 10 22 11 24 12 26 13 28 14 30 15 32 16 34 17 36 18 38 19 40 20 42 21 44 22 46 23 48 24 50 25 52 26 54 27 56 28 58 29 60 30 62 31 64 32 Total

228 Functional Behavioral Assessment, Diagnosis, and Treatment

Form 5.12 n NCR With Extinction: Simple Plan

• Person served:

• Target behavior:

• Behavioral diagnostic category:

• Target rate:

• Designated time period(s):

• Baseline data across five times/sessions: 1. ___________ 2. ___________ 3. ___________ 4. ___________ 5. ___________

• % of intervals in which target behavior occurred Baseline: Target:

• % of intervals in which reinforcement occurred Baseline: Target:

• Interbehavior interval Baseline: Target:

• Initial schedule of NCR:

l° ____ Fixed time schedule every ____ minutes/hours/days

OR

l° ____ Variable time schedule on average every ___ minutes/hours/days

• Reinforcer(s) to be used: 1. ___________ 2. ___________ 3. ___________ 4. ___________ 5. ___________

l° Special instructions for delivery of reinforcer(s):

• Criterion for increasing the amount of time between reinforcers:

• Criterion for decreasing the amount of time between reinforcers:

• Criterion for withholding the scheduled reinforcer delivery:

5 Functional Behavioral Treatment Protocols for SMA 2.0: Target Behaviors 229

Form 5.13 n Formulas for Calculating Percentage of Intervals of Targeted Behavior and Interbehavior Interval

• Percent of occurrence: This formula will help you determine how often a behavior is occurring. Use this information to assess treatment effects.

l° Total intervals target behavior occurred ÷ Total intervals observed × 100 = % of intervals of target behavior

• Rate: This formula will help you determine on average how much time passes between the occurrence of targeted behaviors (interbehavior interval). Use this information to help set the frequency of NCR.

l° Total minutes observed ÷ Total intervals target behavior occurred = Rate or average interbehavior interval

Form 5.14 n Formulas for Determining Increases or Decreases in Frequency of NCR

• Formula for 10% increase in time between reinforcement.

Current reinforcement interval × 1.10 = (10% increase in time)

• Formula for 5% increase in time between reinforcement.

Current reinforcement interval × 1.05 = (5% increase in time)

• Formula for 10% decrease in time between reinforcement.

Current reinforcement interval × 0.90 = (10% decrease in time)

• Formula for 5% decrease in time between reinforcement.

Current reinforcement interval × 0.95 = (5% decrease in time)

ADDITIONAL RESOURCES Buchanan, J. A., & Fisher, J. E. (2002). Functional assessment and non-contingent reinforcement in the treatment of disruptive vocalization in elderly dementia patients. Journal of Applied Behavior Analysis, 35, 99–103. Carr, J. E., Bailey, J. S., Ecott, C. L., Lucker, K. D., & Weil, T. M. (1998). On the effects of non- contingent delivery of differing magnitudes of reinforcement. Journal of Applied Behavior Analysis, 31, 313–321. Fischer, S. M., Iwata, B. A., & Mazaleski, J. L. (1997). Non-contingent delivery of arbitrary reinforcers as treatment for self-injurious behavior. Journal of Applied Behavior Analysis, 30, 239–249. Fisher, W. W., O’Connor, J. T., Kurtz, P. F., DeLeon, I. G., & Gotjen, D. L. (2000). The effects of non-contingent delivery of high- and low-preference stimuli on attention-maintained destructive behavior. Journal of Applied Behavior Analysis, 33, 79–83. Goh, H., Iwata, B. A., & DeLeon, I. G. (2000). Competition between non-contingent and contingent reinforcement schedules during response acquisition. Journal of Applied Behavior Analysis, 33, 195–205. Goh, H., Iwata, B. A., & Kahng, S. (1999). Multicomponent assessment and treatment of cigarette pica. Journal of Applied Behavior Analysis, 32, 297–316.

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Hagopian, L. P., Crockett, J. L., van Stone, M., DeLeon, I. G., & Bowman, L. G. (2000). Effects of non-contingent reinforcement on problem behavior and stimulus engagement: The role of satiation, extinction, and alternative reinforcement. Journal of Applied Behavior Analysis, 33, 433–449. Hagopian, L. P., Fisher, W. W., & Legacy, S. M. (1994). Schedule effects of non-contingent reinforcement on attention-maintained destructive behavior in identical quadruplets. Journal of Applied Behavior Analysis, 27, 317–325. Hanley, G. P., Piazza, C. C., Fisher, W. W., Contrucci, S. A., & Maglieri, K. A. (1997). Evaluation of client preference for function-based treatment packages. Journal of Applied Behavior Analysis, 30, 459–473. Kahng, S., Iwata, B. A., DeLeon, I. G., & Wallace, M. D. (2000). A comparison of procedures for programming non-contingent reinforcement schedules. Journal of Applied Behavior Analysis, 33, 223–231. Kahng, S., Iwata, B. A., DeLeon, I. G., & Worsdell, A. S. (1997). Evaluation of the “control over reinforcement” component in functional communication training. Journal of Applied Behavior Analysis, 30, 267–277. Kahng, S., Iwata, B. A., Thompson, R. H., & Hanley, G. P. (2000). A method for identifying satiation versus extinction effects under non-contingent reinforcement schedules. Journal of Applied Behavior Analysis, 33, 419–432. Lalli, J. S., Casey, S. D., & Kates, K. (1997). Non-contingent reinforcement as treatment for severe problem behavior: Some procedural variations. Journal of Applied Behavior Analysis, 30, 127–137. Lindberg, J. S., Iwata, B. A., Roscoe, E. M., Worsdell, A. S., & Hanley, G. P. (2003). Treatment efficacy of non-contingent reinforcement during brief and extended application. Journal of Applied Behavior Analysis, 36, 1–19. Marcus, B. A., & Vollmer, T. R. (1996). Combining non-contingent reinforcement and differential reinforcement schedules as treatment for aberrant behavior. Journal of Applied Behavior Analysis, 29, 43–51. Poling, A., & Normand, M. (1999). Non-contingent reinforcement: An inappropriate description of time-based schedules that reduce behavior. Journal of Applied Behavior Analysis, 32, 237–238. Reed, G. K., Piazza, C. C., Patel, M. R., Layer, S. A., Bachmeyer, M. H., Bethke, S. D., Gutshall, K. A. (2004). On the relative contributions of non-contingent reinforcement and escape extinction in the treatment of food refusal. Journal of Applied Behavior Analysis, 37, 27–41. Roscoe, E. M., Iwata, B. A., & Goh, H. (1998). A comparison of non-contingent reinforcement and sensory extinction as treatments for self-injurious behavior. Journal of Applied Behavior Analysis, 31, 635–646. Roscoe, E. M., Iwata, B. A., & Rand, M. S. (2003). Effects of reinforcer consumption and magnitude on response rates during non-contingent reinforcement. Journal of Applied Behavior Analysis, 36, 525–539. Thompson, R. H., Iwata, B. A., Hanley, G. P., Dozier, C. L., & Samaha, A. L. (2003). The effects of extinction, non-contingent reinforcement, and differential reinforcement of other behavior as control procedures. Journal of Applied Behavior Analysis, 36, 221–238. Van Camp, C. M., Lerman, D. C., Kelley, M. E., Contrucci, S. A., & Vorndran, C. M. (2000). Variable-time reinforcement schedules in the treatment of socially maintained problem behavior. Journal of Applied Behavior Analysis, 33, 545–557. Vollmer, T. R. (1999). Non-contingent reinforcement: Some additional comments. Journal of Applied Behavior Analysis, 32, 239–240. Vollmer, T. R., Iwata, B. A., Zarcone, J. R., Smith, R. G., & Mazaleski, J. L. (1993). The role of attention in the treatment of attention-maintained self-injurious behavior: Non-contingent

5 Functional Behavioral Treatment Protocols for SMA 2.0: Target Behaviors 231

reinforcement and differential reinforcement of other behavior. Journal of Applied Behavior Analysis, 26, 9–21. Vollmer, T. R., Ringdahl, J. E., Roane, H. S., & Marcus, B. A. (1997). Negative side effects of non-contingent reinforcement. Journal of Applied Behavior Analysis, 30, 161–164.

SMA FUNCTIONS: PREMACK CONTINGENCY OPTION Brief Description In a Premack contingency, the desired reinforcer is produced following the client’s successful compliance with a designated regimen of tasks or demands. This has also sometimes been referred to as Grandma’s rule, that is, you don’t get your dessert until you eat your vegetables. The more technical definition of the Premack principle is making access to a high probability behavior contingent on performing a low probability behavior (Premack & Bahwell, 1959).

To implement a Premack contingency as a replacement function option, one first determines the maintaining reinforcer for the target behavior. You then determine a set of tasks that have to be performed before access to the reinforcer is delivered. The reinforcing item or activity is withheld until the client performs the specified task.

The advantage of using a Premack contingency as a replacement function option is that it uses the specific reinforcer that was previously maintaining the client’s target behavior. This contingency introduces a requirement to perform a set of tasks that will delay but not eliminate access to the reinforcing item or event. This replacement function option reduces some of the difficulties associated with extinction. It also usually reduces the overall rate of access to the preferred item or event. The Premack contingency option can be used with any SMA subcategory, with the possible exception of SMA 2.2: Peer Attention.

Apparatus Data sheets—See Form 5.15 “Simple Frequency Data With Formulas” Reinforcing items or events—If tangible items or activities have been identified as the

maintaining reinforcers, and will be delivered on a Premack contingency, a sufficient supply must be available.

Baseline Measurement 1. Identify the target behavior’s function. 2. Operationally define or pinpoint the target behavior, with specific criteria for onset

and offset of behavior (if not readily evident). 3. Determine the observation period, possibly by reviewing scatter plot or A-B-C data

to identify periods of time when behavior is highly likely. 4. Construct the data sheet to reflect the length of the observation period, trying to keep

the length reasonably similar during all baseline sessions. 5. During observation, record either the occurrence of the target behavior, the duration

of the target behavior, or the intensity of the behavior (which measure will depend on the target behavior).

6. Repeat step 5 until the observation period ends. 7. Conduct at least five more baseline sessions. 8. Graph or display the data across all baseline sessions.

232 Functional Behavioral Assessment, Diagnosis, and Treatment

Procedures for Premack Contingency 1. Either at certain times of the day or under certain antecedent conditions that occasion

the target access behavior, require the client to engage in a simple designated task, determined by an analysis of client’s level of ability.

2. When the client completes the requirement of the task, provide the reinforcer. 3. Repeat steps 1 and 2 with each request. 4. As a function of success in ameliorating the target behavior, progressively increase

the duration or quantity of the task required. 5. Ensure that the target behavior does not produce the desired reinforcer (extinction).

Procedures for Premack Contingency When Used as a Supplement for an SMA Requesting (Mand) Program

1. Contingent upon a request by the client for the reinforcer, direct the client to engage in a simple designated task, determined by an analysis of client’s level of ability. (Note: initially the only task required will be the request itself.)

2. When the client completes the requirement of the task, provide reinforcer. 3. Repeat steps 1 and 2 with each request. 4. As a function of success in ameliorating the target behavior, progressively increase

the duration or quantity of the task required. 5. Ensure that the target behavior does not produce the desired reinforcer (extinction).

Thinning the Schedule of Delivery of Maintaining Reinforcer

Once the target behavior is reduced, the behavior analyst can increase the response effort or time delay to obtain the desired event or item. This can be done in two ways:

1. Increase the duration or complexity of each task. 2. Increase the number of tasks required to earn the reinforcer.

Progressively altering either or both of these factors will increase the length of time the client will have to wait before getting the reinforcer following a request.

If utilizing this behavior option for DA behaviors: Utilize the same baseline and treatment procedures as above, except that chain interruption would occur instead of extinction when the target behavior is displayed.

How It Works It is often the case that the social environment has made it too easy for the person to get certain events or reinforcers. Therefore, access to such events occurs at unreasonable levels. To want someone’s attention is not a sin! But it is tough to accommodate such a desire when it is demanded every few minutes. While this may be an acceptable state of affairs for infants, as children get older they have to be “weaned off ” of such frequent and lengthy attention from their parent. Some children do not undergo such conditioning and learn to engage in disruptive and disastrous behaviors to continually access attention or preferred items or activities. The same problem can occur once the person is taught to request reinforcers. Requesting may occur too often once developed, with access to the tangible or social reinforcer provided beyond a reasonable level. Hence, this Premack contingency program also is used to supplement the requesting program described earlier.

A Premack contingency is well suited to reduce the client’s constant desire for a given reinforcer. Requiring the performance of a less preferred task as a condition for access to reinforcement is a strategy that will eventually “wean them off ” of frequent access. Clinical applications of the Premack contingency typically result in the client not requesting the

5 Functional Behavioral Treatment Protocols for SMA 2.0: Target Behaviors 233

desired event as often, given the requirement to perform tasks to access the reinforcer. In these cases, there was also no increase in target behavior.

Hypothetical Example

Potato Chips: Bet You Can’t Have Just One

Mary, a client diagnosed with schizophrenia, was referred for behavior analysis services due to engaging in property destruction while at her day program.

The initial referral to the behavior analyst, Ms. Chance, stated that the staff needed help with Mary’s property destruction. Ms. Chance went to the day program and interviewed several staff. She then constructed Table 5.12 from the information provided.

Ms. Chance observed Mary on several occasions and noticed that there was a pattern of escalating behavior. It often started with a simple request by Mary to get more chips. When such a request was ignored, Mary engaged in behavior that resulted in her going to the break room. When Mary was sent to the break room, someone usually gave her another bag of chips. On some occasions several bags were obtained, depending on which staff person was escorting her to the break room. Given that the behavior was frequently followed by the addition of staff interaction and chips, it seemed likely that the behavior served an access function. Ms. Chance considered an escape function; however, Mary had demonstrated several behaviors that were effective in escaping and avoiding demands in the day program, so she concluded that escape was unlikely to be the function. Additionally, the target behavior rarely occurred under task demand conditions. This information seemed to rule out socially mediated escape (SME) diagnoses.

Ms. Chance observed that the target behavior happened only when other people were around and never when Mary was alone. She considered a SMA 2.1: Staff Attention diagnosis but ruled it out because she observed Mary using skills that were very effective in both initiating and maintaining conversations with staff members. She considered a SMA 2.2: Peer Attention diagnosis but ruled it out because the rate of Mary’s target behavior did not change based on the presence or absence of peers.

This left the most likely diagnosis to be SMA 2.3: Tangible Reinforcer, food item, specifically an extra bag of chips (see Table 5.13).

Ms. Chance presented her hypothesis to the treatment team. The team expressed some concern and disagreement with Ms Chance’s analysis. They believed that the property destruction was a direct result of the client’s auditory hallucinations and should be treated

TABLE 5.12 n SUMMARY OF A-B-C OBSERVATIONS ACCESSING CHIPS

Antecedent Conditions

Target Behavior What Happened? What Was Natural Result of Behavior?

During break after having eaten her snack, asks for a bag of chips. Staff said no.

Threw plate on the floor, refused to pick it up, yelling, asked to go to a quiet area because the voices were bothering her.

Went to quiet area for 5 minutes. Received bag of chips after remaining calm.

Irrelevant.

Doing an art project, eating some chips and drinking a soda, getting close to lunch. Asked for additional chips from staff; staff said no.

Shredded the project she had just completed. Threw paints on the floor and said she had demons in her.

Stopped doing the art project and went to quiet area until lunch break. Received chips with lunch.

Irrelevant.

234 Functional Behavioral Assessment, Diagnosis, and Treatment

with increased dosages of antipsychotic medication. The basis for their belief was that Mary reported hearing voices during these property-destructive incidents.

As a point of compromise, Ms. Chance offered to test her hypothesis over the next 5 days. The test was a simple one. About every 60 minutes, Mary would be given two bags of chips. If hallucinations were a driving factor for the property-destructive behavior, the addition of the chips should have no effect. However, if chips were enabling the function of the target behavior, the rate should decrease. The team agreed, and the test was implemented. During these 5 days, there were no reports of auditory hallucinations, no requests to go to the break room, and no incidents of property destruction.

This new information was presented to the team. The team would not give up their belief about Mary’s hallucinations being key to property destruction, even with the new evidence. They indicated that the change in these behaviors was probably due to a progress with Mary’s condition and that the chips being given to her were irrelevant. To test this hypothesis, they all agreed to simply withhold chips entirely for several days to see what happened. They removed all bags of chips from the day program area to ensure that none would be inadvertently provided. During the next 5 days, Mary reported auditory hallucinations each day, went to the break room one to three times per day, and engaged in property destruction on four occasions (see Example Form 5.15). The following week they returned to providing two bags of chips about every 60 minutes, and again there were no reports of auditory hallucinations, no requests to go to the break room, and no events of property destruction.

Finally, the team agreed that the unwanted behaviors seemed to be functioning to produce the desired bags of chips.

Ms. Chance could have continued providing two bags of chips every 60 minutes; however, that would pose a problem. The consumption of that amount of potato chips daily would pose a significant health risk. Simply reinforcing requesting behavior was also not a practical plan for Mary for the same reason.

Ms. Chance decided that a Premack contingency might work in this case to enable a new set of behaviors as functional in accessing chips. The Premack contingency would also allow a gradual reduction in the desire for such chips over time, as the work requirement increased.

Ms. Chance developed a list of activities based on observing things that Mary would occasionally complete. (Note: These are not functionally equivalent replacement behaviors, they are arbitrarily selected tasks.)

Ms. Chance then set up a Premack contingency (see Example Form 5.16). Any time Mary made a request for chips, the following contingencies were introduced. Mary could earn a bag of chips after she combed her hair. To earn a second bag before the next break, she would be required to brush her teeth and record her self-report of symptoms and side effects of medication. To earn a third bag, she would need to complete an assembly

TABLE 5.13 n DIAGNOSTIC TABLE

Diagnosis SMA 2.3: Tangible Reinforcer, Food Item

Target behavior(s): Property destruction

Function: Access food item potato chips

Target behavior likely under following contexts:

Anytime Mary sees a bag of chips or is informed that chips are in the facility

Target behavior unlikely under following contexts:

After she has consumed several bags of chips

Rule out: SMA 2.1: Staff Attention SMA 2.2: Peer Attention

SMA, socially mediated access.

5 Functional Behavioral Treatment Protocols for SMA 2.0: Target Behaviors 235

Example Form 5.15 n Frequency Count Data Sheet

• Client: Mary Chart Started: _________________

Day/Month/Year

• Behavior: Hallucinations and property destruction

• Total Observation Time: 1,800 min (1, 360-minute session/day)

• Session Length: 360 min

• Number of Days: 5

• Place an X on the appropriate day box each time the target behavior occurs

A. Total minutes observed: 1,800

B. Total occurrences observed: 11 Rate/minute = B/A 11/1,800 = .006

C. Range (low) 1 to (high) 3, Avg = 2.2 Rate/hour = (B/A)60 (11/1,800)60 = 0.37

A. Total minutes observed: 1,800

B. Total occurrences observed: 4 Rate/minute = B/A 4/1,800 = .002

C. Range (low) 0 to (high) 1, Avg = 0.8 Rate/hour = (B/A)60 (4/1,800)60 = 0.13

1 2 3 4 5 Totals

Reports of hallucinations

x xxx xx xxx xx

Daily rate 1 3 2 3 2 11

1 2 3 4 5 Totals

Property destruction x x x x 4

Daily rate

task, do systematic relaxation, and either set up or clean the break room. In this way, her requests could always be fulfilled but with increasing effort on her part and a concomitant time delay in accessing the chips.

The plan was implemented, and Ms. Chance graphed property destruction as well as hair brushing (see Figure 5.4). The intervention had a clear effect on the rate of property destruction and increased the rate of hair brushing.

There was some concern that Mary was now eating chips nonstop. Ms. Chance graphed the number of bags of chips Mary was earning per day and included Mary’s report of hallucinations as there had been some concern that this intervention would be too stressful and increase her symptoms. As can be seen in Figure 5.5, the Premack contingency had an immediate effect on Mary’s report of hallucinations. This reduction continued across the intervention. Mary did increase her chip intake for a period of time, but as the Premack contingency was systematically increased, her chip intake reduced to one bag per day.

236 Functional Behavioral Assessment, Diagnosis, and Treatment

What If?

What if the person refuses to do the required behavior?

If your analysis is correct, the person should, after some short period of time, engage in the low probability behavior because it allows access to some preferred event. If this does not occur, assess to make sure the person can actually perform the low probability behavior, that is, he or she does not have a skills deficit. You may reduce the difficulty of the low probability behavior to make it more likely the person will contact the reinforcer.

What if I cannot prevent the person from engaging in the behavior to be used as a reinforcer?

In order to use the Premack contingency, you must have an effective chain interruption procedure if the behavior is a DA diagnosis. If you cannot do this, it is best to use one of the other intervention programs initially, such as NCR, prior to attempting a Premack contingency.

PREMACK TASK LIST Person served: Mary List of activities to be required prior to accessing chips

Description of activities including any idiosyncrasies, such as time of day or who delivers the reinforcer.

1 Go for a walk

2 Painting

3 Reading

4 Talking with friends

5 Working on assembly tasks

6 Setting up the break room for snacks/lunch

7 Systematic relaxation

8 Cleaning up after break/lunch

9 Self report recording of symptoms and side effects

10 Brush teeth

11 Comb hair

5 Functional Behavioral Treatment Protocols for SMA 2.0: Target Behaviors 237

Example Form 5.16 n Premack Contingency: Simple Plan

• Person served: Mary

• Target behavior: Property destruction

• Behavioral diagnostic category: SMA 2.3: Tangible Reinforcer, food item, chips

• Designated time period(s): During day program

• Initial standard for low probability behavior: Upon making a request for chips, Mary will be asked to complete the following: Combing her hair for 2 minutes.

• Description of how high probability behavior will be provided (how much, how often, etc.): Will be given one bag of chips to consume; if she wants a second bag before the next break time, see special instructions.

• Criterion for increasing the duration/complexity of the low probability behavior: When Mary has gone 5 consecutive days with no property destruction, increase the low probability behavior required by adding one additional task from the table prior to her having access to the bag of chips.

• Criterion for decreasing the duration/complexity of the low probability behavior: If Mary engages in property destruction for two consecutive days, change the required response to setting up or cleaning the break room.

• Procedure for withholding/preventing the high probability behavior if not earned: Bags of chips will be maintained in a locked cabinet and given only at break times or if Mary meets the contingency.

• Special instructions for delivery of reinforcer(s): If Mary has already earned one bag of chips during the time period before a break/lunch and wants to earn another bag, she may do so by completing two times the number of tasks specified in the low probability behavior description.

• Baseline data across five times/ sessions:

1. 2 2. 3 3. 1 4. 3 5. 2

• Rate of low probability behavior Baseline: 0/day Target: 2/day

• Rate of high probability behavior Baseline: 2.2/day Target: 0

238 Functional Behavioral Assessment, Diagnosis, and Treatment

Baseline

5957555351494745434139373533312927252321191715131197531 61

Mary Property Destruction and Hair Pulling

Property destruction

Fr eq

ue nc

y

0

3

2

1

4

Hair brushing

Days

FIGURE 5.4 n Property destruction and hair pulling.

Baseline

5957555351494745434139373533312927252321191715131197531

Mary Hallucination Reports

Reports of hallucinations

Fr eq

ue nc

y

0

3

2

1

4

Bags of chips

Days

FIGURE 5.5 n Hallucinations and chip consumption.

5 Functional Behavioral Treatment Protocols for SMA 2.0: Target Behaviors 239

Form 5.15 n Simple Frequency Data With Formulas

Client: _________________________ Chart Started: ______________

Day/Month/Year

• Behavior: _________________________________________________________

• Total Observation Time: min (___, ___-minute session/day)

Session Length: min

• Number of Days: __

• Place an X on the appropriate day box each time the target behavior occurs

A. Total minutes observed: __

B. Total occurrences observed: __ Rate/minute = B/A / = ____

C. Range (low) __ to (high), Avg = Rate/hour = (B/A)60 ( / )60 = ____

A. Total minutes observed: __

B. Total occurrences observed: __ Rate/minute = B/A / = ____

C. Range (low) __ to (high) __, Avg = __ Rate/hour = (B/A)60 ( / )60 = ____

8 9 10 11 12 13 14 Totals

Target behavior

Daily rate

1 2 3 4 5 6 7 Totals

Target behavior

Daily rate

Forms: Premack Contingency

5.15 Simple Frequency Data With Formulas 5.16 Premack Contingency: Simple Plan

240 Functional Behavioral Assessment, Diagnosis, and Treatment

Form 5.16 n Premack Contingency: Simple Plan

• Person served: _____________________________________________________

• Target behavior: ____________________________________________________

• Behavioral diagnostic category: _________________________________________

• Designated time period(s): _____________________________________________

• Baseline data across five times/sessions:

1. ___________

2. ___________

3. ___________

4. ___________

5. ___________

• Rate of low probability behavior Baseline: __________ Target: __________

• Rate of high probability behavior Baseline: __________ Target: __________

• Initial standard for low probability behavior: ________________________________ ________________________________________________________________

• Description of how high probability behavior will be provided (how much, how often, etc.): ___________________________________________________________

• Criterion for increasing the duration/complexity of the low probability behavior: ___ ________________________________________________________________

• Criterion for decreasing the duration/complexity of the low probability behavior: ___ ________________________________________________________________

• Procedure for withholding/preventing the high probability behavior if not earned: ___ _________________________________________________________________

l° Special instructions for delivery of reinforcer(s):

____________________________________________________________

_____________________________________________________________

_____________________________________________________________

ADDITIONAL RESOURCES Allison, J. (1976). Contrast, induction, facilitation, suppression and conservation. Journal of the Experimental Analysis of Behavior, 25, 185–198. Amari, A., Grace, N. C., & Fisher, W. W. (1995). Achieving and maintaining compliance with the ketogenic diet. Journal of Applied Behavior Analysis, 28, 341–342. Hanley, G. P., Iwata, B. A., Roscoe, E. M., Thompson, R. H., & Lindberg, J. S. (2003). Response- restriction analysis: II. Alteration of activity preferences. Journal of Applied Behavior Analysis, 36, 59–76. Hanley, G. P., Iwata, B. A., Thompson, R. H., & Lindberg, J. S. (2000). A component analysis of “stereotypy as reinforcement” for alternative behavior. Journal of Applied Behavior Analysis, 33, 285–297.

5 Functional Behavioral Treatment Protocols for SMA 2.0: Target Behaviors 241

Homme, L. E., de Baca, P. C., Devine, J. V., Steinhorst, R., & Rickert, E. J. (1963). Use of the Premack principle in controlling the behavior of nursery school children. Journal of the Experimental Analysis of Behavior, 6, 544. Konarski, E. A., Jr., Johnson, M. R., Crowell, C. R., & Whitman, T. L. (1980). Response deprivation and reinforcement in applied settings: A preliminary analysis. Journal of Applied Behavior Analysis, 13, 595–609. Mitchell, W. S., & Stoffelmayr, B. E. (1973). Application of the Premack principle to the behavioral control of extremely inactive schizophrenics. Journal of Applied Behavior Analysis, 6, 419–423. Mithaug, D. E., & Mar, D. K. (1980). The relation between choosing and working prevocational tasks in two severely retarded young adults. Journal of Applied Behavior Analysis, 13, 177–182. Premack, D. (1963). Rate differential reinforcement in monkey manipulation. Journal of the Experimental Analysis of Behavior, 6, 81–89. Premack, D. (1970). A functional analysis of language. Journal of the Experimental Analysis of Behavior, 14, 107–125. Premack, D., & Bahwell, R. (1959). Operant-level lever pressing by a monkey as a function of interest interval. Journal of the Experimental Analysis of Behavior, 2, 127–131. Premack, D., & Premack, A. J. (1963). Increased eating in rats deprived of running. Journal of the Experimental Analysis of Behavior, 6, 209–212. Premack, D., & Schaeffer, R. W. (1962). Distributional properties of operant-level locomotion in the rat. Journal of the Experimental Analysis of Behavior, 5, 89–95. Premack, D., & Schaeffer, R. W. (1963). Some parameters affecting the distributional properties of operant-level running in rats. Journal of the Experimental Analysis of Behavior, 6, 473–475. Premack, D., Schaeffer, R. W., & Hundt, A. (1964). Reinforcement of drinking by running: Effect of fixed ratio and reinforcement time. Journal of the Experimental Analysis of Behavior, 7, 91–96.

SMA FUNCTIONS: ACCESS MAND (REQUEST) OPTION Brief Description In this replacement behavior option, the desired reinforcer, whether it be social attention or access to tangible reinforcer, is accessed upon an appropriate request (mand) from the client. Concurrently, the target behavior no longer functions to efficiently access the desired reinforcer, that is, programmed extinction.

To implement a requesting behavior program for a target behavior that is diagnosed with an SMA function, you should first determine what specific form the request should take. Next, when the new requesting behavior occurs, it is reinforced each time with the specific items or event that was requested. If the target behavior occurs, the reinforcer is not provided until the person engages in the specified requesting behavior. By providing reinforcement in this way, we ensure that engaging in the replacement requesting behavior results in a differentially higher rate of reinforcement than the target behavior (differential reinforcement of an alternate behavior [DRA]).

The advantage of using this procedure is that it develops or teaches a specific behavior that will result in access to a specific reinforcer when the person is most motivated to obtain that particular reinforcer. This makes the acquisition of the skill relatively rapid and generally results in a robust response that can be shaped and generalized to overcome other target behaviors. A disadvantage of this option involves an initial interruption in routine due to immediately complying with the person’s request by delivering the specific item or event. This option is a bit more labor intensive than the DRO option and requires a higher level of expertise and interaction on the part of those implementing the intervention.

242 Functional Behavioral Assessment, Diagnosis, and Treatment

Terms Mand: A verbal operant behavior under the control of a specific motivating operation that

produces a socially mediated specific reinforcer. In the case of a positive reinforcer, a mand involves a request for access to a specific reinforcer. The form may be vocal, sign language, gestural, written, or any combination that has a specific desired effect on the audience of this request.

Apparatus Data sheets—See Form 5.17 “Simple Frequency Data on Target and Replacement Behaviors” Reinforcing items or events—If tangible items or activities have been identified as the main-

taining reinforcers and will be delivered, a sufficient supply must be available.

Baseline Measurement It is important to first determine the form of the requesting behavior that will be developed or increased prior to baseline data collection. Next, collect baseline data on both the target behavior and the replacement behavior using Form 5.17.

If the frequency of the requesting behavior is low, you might consider contriving an antecedent condition that deprives or withholds the maintaining reinforcer, and observe what behavior occurs (target or replacement behavior). See “Trigger Analysis” in Chapter 2 for greater detail on conducting this assessment. Realize that the conditions of deprivation have to be extant in order for either behavior to be realized. Try to make sure that no one provides the reinforcer prior to your assessment.

A simple frequency data sheet such as Form 5.17 should provide sufficient baseline data to decide how to proceed with your assessment and intervention.

Procedures 1. Identify the reinforcer (e.g., food, toys, drink, physical contact). 2. Identify the time and setting when the reinforcer is not readily available, and ensure

that the client is slightly deprived of it (i.e., wants it). It is essential that the client be motivated to access the desired item or event. The judgment of when the client wants the item can generally be along the same conditions and times under which the SMA target behavior occurred. Using the same level of deprivation that existed as a motivating condition for the problem behavior, you now use the following procedures to develop the replacement behavior.

3. Determine the initial request response to be targeted for reinforcement (with access to specific reinforcer), for example, vocal response, manual signed response, pointing to a communication board, and so forth.

4. Present the general instruction “What do you want?” with the item, object, or activity within sight.

5. Use a prompt that is as intrusive as necessary to evoke the request. 6. Contingent upon the occurrence of the specified requesting behavior, present the

reinforcer in small quantities (e.g., a piece of food) or short duration (e.g., 2 minutes of toy play), and record the occurrence of the behavior on the data sheet.

7. If the target behavior occurs, remove the reinforcer for a short period of time and start again at step 4 (extinction).

8. Repeat steps 3 to 6 for as long as the person is motivated to request the reinforcer. When the person’s enthusiasm wanes, end access to the reinforcer until motivation can be re-established.

9. As the client becomes more competent, provide less of a prompt, and time delay the prompt, allowing him or her the opportunity to respond ahead of the prompt.

5 Functional Behavioral Treatment Protocols for SMA 2.0: Target Behaviors 243

10. Provide opportunities for requesting in real life by occasionally depriving the client of some reinforcer for a brief period of time, then reinforcing (and if necessary prompting) the request.

If utilizing this behavior option for DA behaviors: Utilize the same baseline and treatment procedures as above, except that chain interruption would occur instead of extinction when the target behavior is displayed.

How It Works Teaching a requesting behavior (mand) works by establishing an alternate form of behavior that will allow the person to more effectively and efficiently access the same maintaining reinforcer as the target behavior. Once the person has a behavior in his or her repertoire that can function as a request, you enable its function by making sure that it is more effective and efficient than the target behavior in accessing reinforcement. Once the mand is functional, the fading or thinning process allows for the natural contingencies in the environment to control the requesting behavior so that it will maintain over time.

Hypothetical example

As an example, let us examine a case of a child who drops to the floor regularly. Mr. Smith, a school psychologist, was asked to assess the female student. He began by reviewing available records and interviewing the teaching staff. Mr. Smith was informed by the teaching staff that several interventions had been tried with little success. The classroom staff tried pleading with the student to get up, but to no avail. They had tried ongoing counseling as well as crisis counseling when she was lying on the floor. One of the teacher’s aides did mention that the only thing that would get her to cooperate in the classroom was looking at her favorite picture book. Given this information and the fact that the staff at this point were somewhat frustrated with the lack of success, Mr. Smith decided to perform a descriptive functional assessment (A-B-C analysis) from his direct observations. Table 5.14 summarizes his findings.

Mr. Smith noticed that falling to the floor occurred if the student was required to work on a task but that it also occurred when she had no academic demands placed on her. He

TABLE 5.14 n SUMMARY OF FALLING TO THE FLOOR A-B-C DATA

Antecedent Conditions Target Behavior

What Happened? What Was Natural Result of Behavior?

1. In resource room, completed math task; asked to read from workbook.

Fell to floor. Teacher requested that she get up (x4), teacher rubbed her shoulders (x2), teacher got favorite book and presented it at the table. Student got up and looked at book with teacher.

Possible sensation produced when lying on the floor.

2. Finished reading from workbook; class preparing for lunch.

Fell to floor. Teacher requested that she get up (x2), teacher rubbed her shoulders and then teacher offered to sit with her at lunch and read her book. Student got up, picked up her book, and went to lunch with teacher.

Possible sensation produced when lying on the floor.

3. Working on math task. Completed task. Sitting at desk quietly; no interaction for 5 minutes.

Fell to floor and brief loud vocalization.

Teacher requested that she get up (x1), teacher rubbed her shoulders (x4), teacher got favorite book and presented it at the table. Student got up and looked at book with teacher.

Possible sensation produced when lying on the floor.

244 Functional Behavioral Assessment, Diagnosis, and Treatment

concluded that the falling behavior was probably not functioning to escape an instructional task or demand. He also noticed that the interaction with the teacher and her favorite book were more likely to be given to her immediately after falling behavior occurred. He then turned to identifying if the reinforcer was directly accessed or socially mediated. He interviewed several staff and family members who indicated that she had never been known to fall on the floor if she was alone. He concluded that the falling behavior was most likely functioning to access socially mediated reinforcement (SMA category).

Mr. Smith set about determining the specific SMA diagnosis. He reviewed the available data and found that the falling on the floor behavior occurred even while the teaching staff were interacting with the student, regardless of which staff person was involved with her. This ruled out SMA 2.1: Adult Attention. He also ruled out SMA 2.2: Peer Attention because falling behavior happened when peers were present and when they were not.

Mr. Smith noticed that in each event of falling behavior the student got up off the floor only when her favorite book was offered to her. It did not seem to matter who offered the book. He was convinced that SMA 2.3: Tangible Reinforcer (favorite picture book) was the most likely diagnosis (see Table 5.15).

Mr. Smith tested his hypothesis by making sure that the student did not have access to the picture book for several hours. He then waited for her to fall on the floor. He had instructed the staff to do nothing when the student fell to the floor. When the target behavior occurred, Mr. Smith picked up her favorite picture book, making sure that the student saw the book in his hands, placed the book on her desk, and walked away. The student immediately got up off the floor and began to look at the book. Mr. Smith was now sure of his diagnosis.

Because this student was currently not capable of significant vocal speech, a nonvocal request needed to be considered. Mr. Smith decided to develop a plan that calls for the student to use a nonvocal request, such as raising her hand, as the behavior that will be socially mediated and will result in the delivery of her favorite book. Falling on the floor will be disabled through the use of programmed extinction. This dual contingency is specified in Table 5.16.

Note that in Table 5.16, the request (raises her hand) for the teacher to bring the book to read is designated as the replacement mand behavior. Such a request will now result in an

TABLE 5.15 n DIAGNOSTIC TABLE FALLING TO THE FLOOR

Diagnosis SMA 2.3: Tangible Reinforcer (Favorite Picture Book)

Target behavior(s): Falling on the floor during class.

Function: Access to favorite picture book.

Target behavior likely under following contexts:

If it has been longer than 1 hour since the student had looked at the picture book.

Target behavior unlikely under following contexts:

While looking at the picture book or immediately following looking at the book.

Rule out: SMA 2.1: Adult Attention DA 1.1: Immediate Sensory Stimulation

TABLE 5.16 n EXAMPLE OF REPLACEMENT BEHAVIOR—REQUESTING BEHAVIOR

Reinforcer Undesired Form (Target Behavior)

Replacement Behavior

Adult reads/shows student favored book.

Falls to the floor. Request (raises hand) for adult to bring book.

5 Functional Behavioral Treatment Protocols for SMA 2.0: Target Behaviors 245

adult providing her with the book. Prior to writing the plan, Mr. Smith requested that the teacher record some data on the frequency of falling to the floor behavior and the frequency of raising one’s hand across 55-minute observation sessions over 6 days. The data was recorded on Example Form 5.17.

With this frequency data in hand, and an understanding of the function of the falling behavior, Mr. Smith designed an intervention plan. He determined that the falling behavior occurred about every 55 minutes. He also knew that falling occurred only if the student had been deprived of access to her picture book. Additionally, his data indicated that the student very rarely exhibited the replacement behavior of raising her hand.

While there were many replacement behavior options that could be used to stop the falling behavior, Mr. Smith decided that a requesting behavior would not only address the current problem, but would be a skill that the student would need in various situations in the future. Mr. Smith decided that the requesting behavior he would try to establish first was having the student raise her hand. This is the general behavior used in most classroom settings if you want to request something. He further decided that for the behavior to be effective, the student would have to do it while seated at her desk. Mr. Smith knew that the targeted behavior of falling to the ground was more likely around 11 a.m. each day, when the student was at her desk. He decided the best way to capture a high level of motivation for the picture book was to set up training for about 11 a.m. in the classroom at the student’s desk. Mr. Smith made sure that at all other times the picture book would be placed in the teacher’s desk so that there would be no chance of inadvertently reducing the motivation for the book by allowing free access.

Mr. Smith set the initial reinforcement schedule for every incident of hand raising to produce 1 minute of time with the picture book. In this way, Mr. Smith would ensure a high rate of reinforcement for the preferred requesting behavior of the student raising her hand. To increase the speed of this process, Mr. Smith also specified an extinction contingency. If the student engaged in falling on the floor, the picture book would be unavailable to her for 3 minutes. After 3 minutes, prompting of the replacement mand behavior would resume.

Mr. Smith specified that the following prompt sequence should be used, during times when falling to the floor was more likely. The first prompt would be delivered vocally and

Example Form 5.17 n Frequency Count Data Sheet

• Client: Student A Chart Started: ________________

Day/Month/Year

• Behavior: Falling to floor

• Total Observation Time: 330 min (2, 55-minute session/day)

Session Length: 55 min

• Number of Days: 6

• Place an X on the appropriate day box each time the behavior occurs

A. Total minutes observed: 330

B. Total target behavior occurrences observed: 6

C. Total replacement behavior occurrences observed: 1

Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Totals

Falling to floor x xxx xx 6

Raising hand x 1

246 Functional Behavioral Assessment, Diagnosis, and Treatment

progress to more helpful or intrusive prompts if hand raising did not occur. The instructions to the staff were as follows:

1. Provide the prompt “What do you want?” 2. If no response, provide the prompt again with the book in view. 3. If no response, provide the prompt with the addition of a gestural prompt. 4. If no response, provide the prompt with the addition of modeling the response. 5. If no response, provide the prompt with the addition of a physical prompt. 6. If no response, provide increasing physical prompt using least to most prompting. 7. Once the request occurs, provide the requested reinforcer. 8. Repeat for as long as the student is motivated to request the reinforcer. When

enthusiasm wanes, end access to the book.

Mr. Smith also wanted to make sure that the student would eventually raise her hand when she wanted the picture book without anyone prompting her to do so. In order to accomplish this, he developed a plan for slowly decreasing the prompts that were provided. He determined that once the student could raise her hand with prompts for 3 consecutive days, the response was learned to a level that allowed him to reduce or fade the prompts. He decided to do this in two ways. First, Mr. Smith set up a brief delay in the delivery of the prompts. That is, when the book was taken out of the desk for a training session, rather than give the student a vocal prompt, he would wait 5 seconds to allow her to raise her hand independently. Second, he reduced the vocal prompt to simply “what?” with a plan to further stop the vocal prompt entirely. As the student continued to demonstrate hand raising as a way to request the book, Mr. Smith would occasionally delay doing the formal training procedure and wait for the student to independently raise her hand, at which time the picture book would be taken out of the desk and provided to her (see Example Form 5.18).

The plan was implemented and produced the data displayed in Figure 5.6. As Mr. Smith expected, this plan was successful in reducing the occurrence of falling behavior and increasing

Example Form 5.18 n Teaching Requesting Behavioral Plan

• Person served: Student A

• Target behavior: Falling on floor

• Behavioral diagnostic category: SMA 2.3: Tangible Reinforcer, favorite book

• Requesting behavior: Requesting book

A. Form of request: vocal request; manual signed request; requesting by pointing to a communication board; use augmentative device to request; Other: gesture

B. Description of initial request to be reinforced: Rising of her hand while seated

• Reinforcer(s) to be used: Type Amount of time

1. Picture book 1. 1 min

2. ___________ 2. _____

• Target rate: Greater than once per hour

• Instructions to assure motivation:

Train at time and place that target behavior is most likely, which is:

Training at 11:00 a.m. in the classroom at her desk

Assure limited access to reinforcing item at other times by: The book will be kept in the teachers desk drawer at all other times.

(continued )

5 Functional Behavioral Treatment Protocols for SMA 2.0: Target Behaviors 247

the rate of hand raising. By 1/14 the requesting behavior had met the criteria for fading prompts. The prompts were successfully faded, and the student was requesting her book independently. Falling behavior occurred on two occasions after hand raising was established.

After reviewing the two falling incidents, Mr. Smith determined that he needed to generalize the requesting behavior to items other than the picture book. Based on the success of this program, it was determined that the student could probably learn American sign language quickly, so a specific program to help her develop signed requests (mands) was developed.

• Rate of target behavior Baseline: 1/hr Target: 0/day

• Rate of requesting behavior Baseline: 1/day Target: 1/hr

• Initial schedule of differential reinforcement:

A. Provide contrived reinforcer after every 1 (number of) requests and with no more than a 5 sec delay

• Targeted final schedule of differential reinforcement:

A. Assure reinforcer delivery after every 2 (number of) requests with no more than a 15 sec/min delay

• Replacement behavior is reinforced:

l° If the requesting behavior occurs independently provide reinforcer requested

l° If the requesting behavior does not occur under the targeted conditions, provide the following prompts: (using Vocal) 1. Provide the prompt “What do you want?” 2. If no response, provide the prompt again with the item item/object/activity

within sight. 3. If no response, provide the above prompt with the addition of a gestural

prompt. 4. If no response, provide the above with the addition of modeling the response. 5. If no response, provide the above with the addition of a physical prompt. 6. If no response, provide increasing physical prompt using least to most

prompting. 7. Once the request occurs, provide the requested reinforcer. 8. Repeat for as long as the child/client is motivated to request the reinforcer. 9. When the client’s “enthusiasm” wanes, you can end access to the reinforcer

for that time period.

• If target behavior occurs:

l° Extinction, (no access to the requested reinforcer) for 3 minutes, then begin prompt sequence for replacement behavior listed above.

l° If replacement Mand behavior occurs after this time period, provide the requested reinforcer.

l° Special instructions for delivery of small amount of reinforcer(s):

________________________________________________________________

________________________________________________________________

• Criterion for fading prompts: When target rate for replacement behavior is reached on 3 consecutive days, reduce the level of helpfulness of the prompt, first by waiting for 5 seconds before providing the prompt, and then by reducing the prompt from vocal to simple hand gestures, and eventually to the level of prompts that would usually be in place in the classroom.

Example Form 5.18 n Teaching Requesting Behavior Plan (continued )

248 Functional Behavioral Assessment, Diagnosis, and Treatment

What If?

What if the behavior does not decrease (or gets worse) with DRA?

When using DRA with extinction we often see an initial worsening of the target behavior. The technical term for this is an extinction burst. Just like its name implies, it is a brief and often intense increase in the target behavior that happens when the behavior no longer produces the reinforcer. You should see a dramatic decrease in the behavior within 3 sessions or days. If the behavior continues at a high rate for longer than that, you will need to confirm that the behavior you have set up as the alternative behavior is actually producing the identified reinforcer. You should also ensure that extinction is indeed occurring for the target behavior. If the alternative behavior has never been observed to occur, consider specifically training the manding behavior in a more structured format prior to using DRA.

What if I cannot ignore some of the target behaviors?

If the target behavior has life-threatening consequences or cannot be ignored, you can program a DRA without extinction. In this case, all the elements of the DRA would be the same with the exception that when the target behavior occurs, we will continue to respond to it as we have in the past. This will make the behavior change process somewhat slower because the difference in level of reinforcement will not be as great. This can be countered to some extent by interrupting the target behavior and using positive practice of the alternative behavior.

What If the person has never been observed to have exhibited a requesting behavior?

In this case, you will have to first teach a behavior that can be used effectively to request some tangible reinforcer. This generally involves a task analysis and some specific teaching procedures to ensure that the skill is well established in the client’s repertoire. Discrete Trial Training and Precision Teaching are procedures that have been used to successfully teach these skills.

Forms: Differential Reinforcement of Other Behaviors With Extinction

5.17 Simple Frequency Data on Target and Replacement Behaviors 5.18 Teaching Requesting Behavior: Simple Plan

12 Frequency Falling and Hand Raising Student A

10

8

Fr eq

ue nc

y pe

r da

y 6

4

2

0

Days 1/2 1/201/191/181/171/161/151/141/131/121/111/101/91/81/71/61/51/41/3 1/21

Falling Hand raising

FIGURE 5.6 n Falling data.

5 Functional Behavioral Treatment Protocols for SMA 2.0: Target Behaviors 249

Form 5.17 n Simple Frequency Data on Target and Replacement Behaviors

• Client: ____________________ Chart Started: __________________

Day/Month/Year

• Behavior: _______________________________________________________

• Total Observation Time: min (___, ___-minute session/day)

Session Length: min

• Number of Days: ___

• Place an X on the appropriate day box each time the behavior occurs

A. Total minutes observed: ___

B. Total target behavior occurrences observed: ___

C. Total replacement behavior occurrences observed: ___

1 2 3 4 5 6 7 Totals

Target behavior

Replacement behavior

8 9 10 11 12 13 14 Totals

Target behavior

Replacement behavior

22 23 24 25 26 27 28 Totals

Target behavior

Replacement behavior

15 16 17 18 19 20 21 Totals

Target behavior

Replacement behavior

250 Functional Behavioral Assessment, Diagnosis, and Treatment

Form 5.18 n Teaching Requesting Behavior: Simple Plan

• Person served: ______________________________________________________

• Target behavior: _____________________________________________________

• Behavioral diagnostic category: __________________________________________

• Requesting behavior:

A. Form of request: vocal request; manual signed request; requesting by pointing to a communication board; use augmentative device to request; other ___________________________________________________

B. Description of initial request to be reinforced: ______________________ _________________________________________________________

• Reinforcer(s) to be used: Type Amount

1. __________ 1. __________

2. __________ 2. __________

3. __________ 3. __________

4. __________ 4. __________

5. __________ 5. __________

• Target rate: _______________________________________________________

• Instructions to ensure motivation:

l° Train at time and place that target behavior is most likely, which is: ___________ _____________________________________________________________

l° Ensure limited access to reinforcing item at other times by:_________________ ______________________________________________________________

l° Designated time period(s) to implement: _______________________________

l° Rate of target behavior Baseline: _________ Target: ________

l° Rate of requesting behavior Baseline: _________ Target: ________

• Initial schedule of differential reinforcement:

A. Provide contrived reinforcer after every _____ number of requests and with no more than a _____ sec/min delay

• Targeted final schedule of differential reinforcement:

A. Ensure reinforcer delivery after every _____ number of requests with no more than a _____ sec/min delay

• Replacement behavior is reinforced:

l° If the requesting behavior occurs independently, provide reinforcer requested

l° If the requesting behavior does not occur under the targeted conditions, provide the following prompts: (using vocal sign, gesture, visual).

1. Provide the prompt, “What do you want?”

2. If no response, provide the prompt again with the item item/object/activity within sight.

3. If no response, provide the prompt with the addition of a gestural prompt.

4. If no response, provide the prompt with the addition of modeling the response.

5. If no response, provide the prompt with the addition of a physical prompt.

(continued )

5 Functional Behavioral Treatment Protocols for SMA 2.0: Target Behaviors 251

ADDITIONAL RESOURCES

Teaching Requesting Skills Arntzen, E., & Almås, I. K. (2002). Effects of mand-tact versus tact-only training on the acquisition of tacts. Journal of Applied Behavior Analysis, 35, 419–422. Bosch, S., & Fuqua, R. W. (2001). Behavioral cusps: A model for selecting target behaviors. Journal of Applied Behavior Analysis, 34, 123–125. Bowman, L. G., Fisher, W. W., Thompson, R. H., & Piazza, C. C. (1997). On the relation of mands and the function of destructive behavior. Journal of Applied Behavior Analysis, 30, 251–265. Brown, K. A., Wacker, D. P., Derby, K. M., Peck, S. M., Richman, D. M., Sasso, G. M., . . . Harding, J. W. (2000). Evaluating the effects of functional communication training in the presence and absence of establishing operations. Journal of Applied Behavior Analysis, 33, 53–71. DeLeon, I. G., Fisher, W. W., Herman, K. M., & Crosland, K. C. (2000). Assessment of a response bias for aggression over functionally equivalent appropriate behavior. Journal of Applied Behavior Analysis, 33, 73–77. Derby, K. M., Wacker, D. P., Berg, W., DeRaad, A., Ulrich, S., Asmus, J., . . . Stoner, E. A. (1997). The long-term effects of functional communication training in home settings. Journal of Applied Behavior Analysis, 30, 507–531. Drasgow, E., Halle, J. W., & Ostrosky, M. M. (1998). Effects of differential reinforcement on the generalization of a replacement mand in three children with severe language delays. Journal of Applied Behavior Analysis, 31, 357–374. Goh, H., Iwata, B. A., & DeLeon, I. G. (2000). Competition between noncontingent and contingent reinforcement schedules during response acquisition. Journal of Applied Behavior Analysis, 33, 195–205. Henry, L. M., & Horne, P. J. (2000). Partial remediation of speaker and listener behaviors in people with severe dementia. Journal of Applied Behavior Analysis, 33, 631–634.

6. If no response, provide increasing physical prompt using least to most prompting.

7. Once the request occurs, provide the requested reinforcer. 8. Repeat for as long as the child/client is motivated to request the reinforcer. 9. When the client’s “enthusiasm” wanes, end access to the reinforcer for that

time period.

• If target behavior occurs:

l° Extinction (no access to the requested reinforcer) for ____ minutes, then begin prompt sequence for replacement behavior listed above.

l° If replacement requesting behavior occurs during this time period, provide the requested reinforcer.

l° Special instructions for delivery of small amount of reinforcer(s): _____________________________________________________________ _____________________________________________________________

• Criterion for fading prompts: __________________________________________ ________________________________________________________________

• Criterion for increasing the amount of delay in the delivery of reinforcer:________ ________________________________________________________________

Form 5.18 n Teaching Requesting Behavior: Simple Plan (continued )

252 Functional Behavioral Assessment, Diagnosis, and Treatment

Kahng, S., Hendrickson, D. J., & Vu, C. P. (2000). Comparison of single and multiple functional communication training responses for the treatment of problem behavior. Journal of Applied Behavior Analysis, 33, 321–324. Lalli, J. S., Mauro, B. C., & Mace, F. C. (2000). Preference for unreliable reinforcement in children with mental retardation: The role of conditioned reinforcement. Journal of Applied Behavior Analysis, 33, 533–544. Marcus, B. A., & Vollmer, T. R. (1996). Combining noncontingent reinforcement and differential reinforcement schedules as treatment for aberrant behavior. Journal of Applied Behavior Analysis, 29, 43–51. Northup, J., Wacker, D., Sasso, G., Steege, M., Cigrand, K., Cook, J., DeRaad, A. (1991). A  brief  functional analysis of aggressive and alternative behavior in an outclinic setting. Journal of Applied Behavior Analysis, 24, 509–522. Partington, J. W., Sundberg, M. L., Newhouse, L., & Spengler, S. M. (1994). Overcoming an autistic child’s failure to acquire a tact repertoire. Journal of Applied Behavior Analysis, 27, 733–734. Peck, S. M., Wacker, D. P., Berg, W. K., Cooper, L. J., Brown, K. A., Richman, D., . . . Millard, T. (1996). Choice-making treatment of young children’s severe behavior problems. Journal of Applied Behavior Analysis, 29, 263–290. Rehfeldt, R. A., & Root, S. L. (2005). Establishing derived requesting skills in adults with severe developmental disabilities. Journal of Applied Behavior Analysis, 38, 101–105. Richman, D. M., Wacker, D. P., & Winborn, L. (2001). Response efficiency during functional communication training: Effects of effort on response allocation. Journal of Applied Behavior Analysis, 34, 73–76. Sprague, J. R., & Horner, R. H. (1992). Covariation within functional response classes: Implications for treatment of severe problem behavior. Journal of Applied Behavior Analysis, 25, 735–745. Tiger, J. H., & Hanley, G. P. (2004). Developing stimulus control of preschooler mands: An analysis of schedule-correlated and contingency-specifying stimuli. Journal of Applied Behavior Analysis, 37, 517–521. Vollmer, T. R., Borrero, J. C., Lalli, J. S., & Daniel, D. (1999). Evaluating self-control and impulsivity in children with severe behavior disorders. Journal of Applied Behavior Analysis, 32, 451–466. Wallace, M. D., Iwata, B. A., & Hanley, G. P. (2006) Establishment of mands following tact training as a function of reinforcer strength. Journal of Applied Behavior Analysis, 39, 17–24. Winborn, L., Wacker, D. P., Richman, D. M., Asmus, J., & Geier, D. (2002). Assessment of mand selection for functional communication training packages. Journal of Applied Behavior Analysis, 35, 295–298. Yamamoto, J., & Mochizuki, A. (1988). Acquisition and functional analysis of manding with autistic students. Journal of Applied Behavior Analysis, 21, 57–64.

Differential Reinforcement of Alternative Behavior Goh, H., Iwata, B. A., & DeLeon, I. G. (2000). Competition between noncontingent and contingent reinforcement schedules during response acquisition. Journal of Applied Behavior Analysis, 33, 195–205. Lee, R., McComas, J. J., & Jawor, J. (2002). The effects of differential and lag reinforcement schedules on varied verbal responding by individuals with autism. Journal of Applied Behavior Analysis, 35, 391–402.

5 Functional Behavioral Treatment Protocols for SMA 2.0: Target Behaviors 253

McCord, B. E., Thomson, R. J., & Iwata, B. A. (2001). Functional analysis and treatment of self-injury associated with transitions. Journal of Applied Behavior Analysis, 34, 195–210. Piazza, C. C., Moes, D. R., & Fisher, W. W. (1996). Differential reinforcement of alternative behavior and demand fading in the treatment of escape-maintained destructive behavior. Journal of Applied Behavior Analysis, 29, 569–572. Ringdahl, J. E., Kitsukawa, K., Andelman, M. S., Call, N., Winborn, L., Barretto, A. (2002). Differential reinforcement with and without instructional fading. Journal of Applied Behavior Analysis, 35, 291–294. Roane, H. S., Fisher, W. W., Sgro, G. M., Falcomata, T. S., & Pabico, R. R. (2004). An alternative method of thinning reinforcer delivery during differential reinforcement. Journal of Applied Behavior Analysis, 37, 213–218. Vollmer, T. R., Roane, H. S., Ringdahl, J. E., & Marcus, B. A. (1999). Evaluating treatment challenges with differential reinforcement of alternative behavior. Journal of Applied Behavior Analysis, 32, 9–23.

255

In this chapter, the material presented in Chapter 4 is expanded to provide a treatment protocol for each replacement function option delineated for socially mediated escape (SME) target behaviors. The treatment protocols for direct escape (DE) are the same as the SME protocols except for some minor variations in the procedures for dealing with the occurrence of the target behaviors. These variations are explicated in each replacement function option.

For SME problem behaviors, the following protocols are presented in this chapter:

ll Premack Contingency Option ll Tolerance Training Option (or Differential Negative Reinforcement of All Other

Behaviors) ll Escape Mand (Protest or Negotiation Behavior) Option ll Alternate Direct Escape Form ll Noncontingent Escape (NCE)

This chapter also contains a protocol for a treatment program called noncontingent reinforcement (NCR). This program was not delineated in Chapter 4 because it does not readily address the function of the target behavior or the development of the replacement function (not one specified). Rather, it works as a result of altering the motivational condition of the client in one of two ways. In the case of target behaviors maintained by negative reinforcement, the NCE program alters behavior by removing the aversive stimulus that generates escape behavior. In this case, it may also establish the conditions for  extinction by disrupting the contingent pairing of the target behavior and the reinforcer.

All the protocols in this chapter, with the exception of NCE, contain a functional arrangement of treatment contingencies. The target behavior’s function is disabled, while the replacement behavior’s function to the relevant reinforcer is enabled.

SME FUNCTIONS: PREMACK CONTINGENCY OPTION Brief Description In a Premack contingency, the desired reinforcer is produced following the client’s successful compliance with a designated regimen of tasks or demands. This has also been referred to as Grandma’s rule, that is, you don’t get your dessert until you eat your

6Functional Behavioral Treatment Protocols for SME 4.0: Problem Behaviors

256 Functional Behavioral Assessment, Diagnosis, and Treatment

vegetables. The more technical definition of the Premack principle is making access to a high-probability behavior contingent on performing a low-probability behavior (Premack & Bahwell, 1959).

To implement a Premack contingency for SME functions, the staff, parent, or teacher determines what negative reinforcer the target behavior is removing (what task, event, or person the unwanted behavior is escaping or avoiding). You would then determine a set of tasks that have to be performed before escape or avoidance is allowed. The reinforcing event (removal of the negative reinforcer) is withheld until the client performs the specified task.

The advantage of using a Premack contingency is that it still allows for escape of the aversive event to be used as a negative reinforcer. The requirement to perform a set of tasks will build in a delay of the removal of the negative reinforcer. The client subsequently learns to tolerate the aversive event or activity for longer periods of time. This replacement function option reduces some of the difficulties associated with extinction. It also usually reduces the overall rate of terminating or avoiding the negative reinforcer (similar to that produced in tolerance training). The Premack contingency can be used with any SME subcategory.

Apparatus Data sheets—See Form 6.1 “Simple Frequency Data With Formulas”

Baseline Measurement 1. Identify the target behavior to be observed. 2. Operationally define or pinpoint the target behavior, with specific criteria for onset

and offset of behavior (if not readily evident). 3. Determine the observation period, possibly reviewing scatter plot or A-B-C data to

identify periods of time when behavior is highly likely. 4. Construct the data sheet to reflect the length of the observation period, trying to keep

the length reasonably similar during all baseline sessions. 5. During observation, record either the occurrence of the target behavior, the duration

of the target behavior, or the intensity of the behavior (which measure you select will depend on the target behavior).

6. Repeat step 5 until the observation period ends. 7. Conduct at least four more baseline sessions. 8. Graph or display the data across all baseline sessions.

Procedures for Premack Contingency 1. Either at specified times of the day or under antecedent conditions that occasion

the target escape behavior, require the client to engage in a simple designated task determined by an analysis of client’s level of ability.

2. When the client completes the designated task, remove the aversive event allowing the client to escape the negative reinforcer.

3. Repeat steps 1 and 2 with each occurrence of the conditions that have in the past preceded escape behaviors.

4. As a function of success in ameliorating the target behavior, progressively increase the duration or quantity of the task required.

5. Ensure that the target behavior does not produce negative reinforcement. (escape extinction)

6 Functional Behavioral Treatment Protocols for SME 4.0: Problem Behaviors 257

Procedures for Premack Contingency When Used as a Supplement for Requesting Program.

1. Contingent upon a request by the client to terminate an activity or event or have an item removed from the area, require the client to engage in a simple designated task, determined by an analysis of client’s level of ability.

2. When the client completes the designated task, remove the aversive event, allowing the client to escape the negative reinforcer.

3. Repeat steps 1 and 2 with each request. 4. As a function of success in ameliorating the target behavior, progressively increase

the duration or quantity of the task required. 5. Ensure that the target behavior does not produce the desired reinforcer (escape

extinction).

Thinning the Schedule of Delivery of Maintaining Reinforcer Once the target behavior is reduced, the behavior analyst can increase the response effort

or time to remove the undesired event or item. This can be done in two ways:

1. Increase the duration or complexity of each task. 2. Increase the number of tasks required to earn the reinforcer.

Progressively altering either or both of these factors will increase the length of time the client will have to tolerate the aversive condition (whether it be a task demand or social situation) before a request to remove the event is honored.

If utilizing this behavior option for direct escape (DE) behaviors: Utilize the same baseline and treatment procedures as above, except that chain interruption would occur instead of extinction when the target behavior is displayed.

How It Works It is often the case that the social environment has made it too easy for the person to escape or avoid certain events. Therefore, escape or avoidance of such events occurs at unreasonable levels. To want to get out of an unpleasant event is not a sin! But it surely is tough to accommodate such a desire when it prevents learning of important life skills or endangers the person’s health. If a child cannot tolerate sitting in a group activity in early elementary school for longer than 30 seconds, such an inability will result in fewer learning opportunities and perhaps removal from the classroom.

A problem may also appear once a mand (request) for escape is taught and acquired. Requesting “out” may occur too often once developed, resulting in the person staying in the relatively aversive situation far too short a time compared to his or her peers. Hence, this Premack contingency program also is used as a supplement to the escape mand (requesting) program.

A Premack contingency is well suited to reduce the client’s desire to avoid a given event. Requiring the performance of a task as a condition for removal of a negative reinforcer is a strategy that will eventually wean the client off of frequent avoidance and increase the ability to tolerate a nonpreferred condition for longer periods of time.

Hypothetical Example

I Need a Break, My Brain Is Swelling

John was a mainstreamed fourth-grade student. The initial referral to the behavior analyst, Ms. White, stated that the staff needed help with John’s tantrum behavior. Ms. White went to the classroom and interviewed the teacher and teacher’s aide. She constructed Table 6.1 from the information they provided.

Ms. White observed John on several occasions and noticed that the target behavior occurred only during reading. John would read for about 5 to 10 minutes, as long as one of the special education personnel were looking at him. As soon as that person turned away, he

258 Functional Behavioral Assessment, Diagnosis, and Treatment

would put down his book and very quietly take out one of his toys and start to play. When one of the aides looked at him, he would attempt to hide the toys by picking up his reading book. When the aide looked away, he would go back to playing with his toys. If the aide caught him and came over and attempted to direct him back to reading, he would begin to complain, yell, throw items off the desk, stomp his feet, and so forth. Following each outburst, the aide directed him to the quiet area in the classroom to allow him time to engage in his “self- calming” skills. He would then return to the class when “calm.” Ms. White noticed that with each self-calming session, the time it took him to calm usually lasted until the assignment changed from reading to math. In other words, as a result of the “self-calming” procedure, he missed the remainder of the reading period.

Ms. White considered the function of such behaviors to possibly be socially mediated access (SMA) SMA 2.1: Staff Attention. However, she ruled this out as John was observed at other times to have very effective skills to start conversations and evoke attention from staff members during other times of the day. The critical piece of information was the timing of the end of the tantrum and self-calming behaviors. It was perfectly correlated with the end of the reading assignment. This left the most likely diagnosis to be SME 4.2: Lengthy Tasks, specifically the reading task (see Table 6.2). It appeared that John could read the material; however, he just ran out of steam at some point in the lengthy reading period.

Ms. White presented her hypothesis to the teacher. The teacher expressed some concern and disagreement with Ms. White’s analysis. She believed that the tantrum was just an effort to get her attention. Ms. White offered to test her hypothesis over the next 6 days. The test was a simple one.

TABLE 6.1 n SUMMARY OF TOY PLAY A-B-C DATA

Antecedent Conditions

Target Behavior What Happened? What Was Natural Result of Behavior?

Given a reading assignment. Starts to read for a few minutes while the staff is watching him.

Gets out some toy cars he brought from home, quits reading, starts to whine and tantrum as soon as the teacher looks at him.

Teacher had to send him out to calm down. He comes back in time to start math.

None noted.

Given a reading assignment. Starts to read for a few minutes while the staff is watching him.

Quits reading and plays with his toys as soon as the aide turns away from him.

Teacher redirects him; he tantrums and gets sent out of class to calm down.

None noted.

TABLE 6.2 n DIAGNOSTIC TABLE FOR TANTRUMS AND TOY PLAY

Diagnosis 4.2 SME: Lengthy Tasks/Chores/Assignments, reading

Target behavior(s): Tantrums and playing with toys during reading periods

Function: Escapes the reading task

Target behavior likely under following contexts:

During reading periods that last longer than 5 minutes

Target behavior unlikely under following contexts:

During any other class time or activity including short duration reading tasks

Rule out: SMA 2.1: Adult Attention

SMA, socially mediated access; SME, socially mediated escape.

6 Functional Behavioral Treatment Protocols for SME 4.0: Problem Behaviors 259

A. Three days with a 1-hour period of coloring pictures; no reading during this time with no attention provided at this time.

B. Three days with a 1-hour period of reading with frequent attention.

For 1 hour each day, John would be alternately asked to engage in either a coloring activity or the usual reading assignments. The time period for these two activities would be the same each of the 6 days. During the coloring activity, he would receive no attention from any of the adults. If he displayed tantrums during this time, it would provide some evidence that the tantrums were functioning to access attention. During the reading period, he would receive frequent attention. If he had more tantrums during this typical reading activity, when compared to the coloring activity, escape motivated tantrum behavior seemed plausible.

The teacher agreed, and Ms. White implemented the procedure. It produced the data presented in Example Form 6.1.

From this data it was very clear that the tantrums were functioning to escape the reading assignments. Ms. White also found that John would engage in the reading assignment for an average of 5 minutes. Any attempts to direct him back to reading after 5 minutes would result in tantrum behaviors. This occurred in all of the reading periods. Ms. White reviewed the Individual Education Plan (IEP) and found there was no indication that John had visual impairments of any kind.

Example Form 6.1 n Frequency Count Data Sheet

• Client: John Chart Started: _________________

Day/Month/Year

• Behavior: Tantrums

• Total Observation Time: 360 min (1, 60-minute session/day)

• Session Length 60 min

• Number of Days: 6

• Place an X on the appropriate day box each time the target behavior occurs

A. Total minutes observed: 180

B. Total occurrences observed: 10

C. Range (low) 2 to (high) 2, Avg = 2

A. Total minutes observed: 180

B. Total occurrences observed: 0

C. Range (low) 0 to (high) 0, Avg = 0

Reading 1 2 3 4 5 6 Totals

Tantrums xx xx xx xx xx

Total 2 2 2 2 2 0 10

Coloring activity 1 2 3 4 5 6 Totals

Tantrums 0

Total 0 0 0 0 0 0 0

260 Functional Behavioral Assessment, Diagnosis, and Treatment

Ms. White could have simply set up a program that allowed a requesting behavior to escape reading (by asking to color instead). This clearly would have ended the tantrum behaviors. However, it would not be conducive to his continued learning and development. She decided that a Premack contingency would be better suited as it would reduce the level of tantrums while slightly increasing the amount of reading time during the beginning phase of intervention. The Premack contingency would also gradually alter John’s desire to escape reading activities over time, as the work requirement (to get out of reading and into coloring) increased. Ms. White had noticed during her observations that John would also play with Sudoku math puzzles during his free time.

Ms. White set up the following Premack contingency. John would be given access to Sudoku math puzzles or coloring activities following completion of a specified amount of reading. In the initial contingency, he could end the reading task and access 5 minutes of Sudoku or coloring by completing one page of reading (see Example Form 6.2).

Example Form 6.2 n Premack Contingency: Plan

• Person served: John

• Target behavior: Tantrums

• Behavioral diagnostic category: SME 4.2: Lengthy Tasks/Chores/Assignments, reading task

• Designated time period(s): Reading period

• Baseline data across five times/sessions: 1. 1 2. 1 3. 1 4. 1 5. 1

• Rate of low-probability behavior: Baseline 0 pgs/period Target 10 pgs/period

• Rate of high-probability behavior: Baseline 1/period Target 0

• Initial standard for low-probability behavior: Upon request by the teacher to begin reading, John will be required to complete 1 page of reading.

• Description of how high-probability behavior will be provided: (how much, how often etc.) Will be provided 5 minutes to play Sudoku or color in a book following each page of reading.

• Criterion for Increasing the duration/complexity of the low-probability behavior: When John has gone 5 consecutive days with no tantrum behaviors, increase the low-probability behavior required by adding one additional paragraph to the reading requirement.

• Criterion for decreasing the duration/complexity of the low-probability behavior: If John engages in tantrums for three consecutive reading periods, change the required response to three paragraphs.

• Procedure for withholding/preventing the high-probability behavior if not earned: All toys will be removed from John and Sudoku puzzles/coloring will be available only from the teacher.

• Special instructions for delivery of reinforcer(s): If John completes multiples of the reading task at one time, he can be given multiples of the reinforcer. That is, if he reads two pages in a row, he can earn 10 minutes of Sudoku, etc.

6 Functional Behavioral Treatment Protocols for SME 4.0: Problem Behaviors 261

The plan was implemented, and Ms. White graphed tantrums as well as pages read. The intervention had a clear effect on the rate of tantrums and increased the rate of reading. Ms. White also graphed the number of times John was earning access to Sudoku or coloring. As can be seen in Figure 6.1, the Premack contingency had an immediate effect on John’s tantrum behavior as well as his reading. John quickly progressed to an acceptable reading standard. During periods 22 thorough 30, he was exceeding  the Premack requirement such that he was accessing Sudoku or coloring for a total of 15 minutes per reading period. His reading output remained relatively high, and as the reading requirement was increased, his total time doing math puzzles decreased. There were two occurrences of tantrum behavior during this intervention. One occurred during the first increase in the response requirement. The second occurred during a stable point in the intervention.

What If?

What if the person refuses to do the required behavior?

You must impose conditions that do not allow escape of the task via any behaviors except those you have specified in the plan, that is, completing tasks. If your analysis is correct, the person should, after some short period of time, engage in the low-probability behavior because it is the only way to escape or avoid the less preferred event.

You must be sure that the client can actually perform the low-probability behavior, that is, he or she does not have a skills deficit (or an inept repertoire diagnosis). You may want to reduce the difficulty of the low-probability behavior to make it more likely the client will contact the reinforcer.

Forms: Premack Contingency

6.1 Simple Frequency Data With Formulas 6.2 Premack Contingency: Simple Plan

FIGURE 6.1 n Reading and tantrums.

Baseline

5957555351494745434139373533312927252321191715131197531 0

12

4

6

8

10

2

14

16

Reading Periods

John Reading

Tantrums Sudoku

Pages read

262 Functional Behavioral Assessment, Diagnosis, and Treatment

Form 6.1 n Simple Frequency Data With Formulas

• Client: Chart Started: _______________

Day/Month/Year

• Behavior:

• Total Observation Time: min (__, ___-minute session/day) Session Length: min

• Number of Days:

• Place an X on the appropriate day box each time the target behavior occurs

A. Total minutes observed:

B. Total occurrences observed:

C. Range (low) to (high) , Avg =

1 2 3 4 5 6 7 Totals

Target behavior

Daily rate

8 9 10 11 12 13 14 Totals

Target behavior

Daily rate

6 Functional Behavioral Treatment Protocols for SME 4.0: Problem Behaviors 263

ADDITIONAL RESOURCES Allison, J. (1976). Contrast, induction, facilitation, suppression and conservation. Journal of the Experimental Analysis of Behavior, 25, 185–198. Amari, A., Grace, N. C., & Fisher, W. W. (1995). Achieving and maintaining compliance with the ketogenic diet. Journal of Applied Behavior Analysis, 28, 341–342. Hanley, G. P., Iwata, B. A., Roscoe, E. M., Thompson, R. H., & Lindberg, J. S. (2003). Response- restriction analysis: II. Alteration of activity preferences. Journal of Applied Behavior Analysis, 36, 59–76.

Form 6.2 n Premack Contingency: Simple Plan

• Person served:

• Target behavior:

• Behavioral diagnostic category:

• Target rate:

• Designated time period(s):

• Baseline data across five times/sessions: 1. 2. 3. 4. 5.

• Rate of low-probability behavior Baseline: ___________ Target: ___________

• Rate of high-probability behavior Baseline: ___________ Target: ___________

• Initial standard for low-probability behavior:

• Description of how high-probability behavior will be provided: (how much, how often, etc.)

• Criterion for increasing the duration/complexity of the low-probability behavior:

• Criterion for decreasing the duration/complexity of the low-probability behavior:

• Procedure for withholding/preventing the high-probability behavior if not earned: _______________________________________________________________

• Special instructions for delivery of reinforcer(s):

264 Functional Behavioral Assessment, Diagnosis, and Treatment

Hanley, G. P., Iwata, B. A., Thompson, R. H., & Lindberg, J. S. (2000). A component analysis of “stereotypy as reinforcement” for alternative behavior. Journal of Applied Behavior Analysis, 33, 285–297. Homme, L. E., de Baca, P. C., Devine, J. V., Steinhorst, R., & Rickert, E. J. (1963). Use of the Premack principle in controlling the behavior of nursery school children. Journal of the Experimental Analysis of Behavior, 6, 544. Konarski, E. A., Jr., Johnson, M. R., Crowell, C. R., & Whitman, T. L. (1980). Response deprivation and reinforcement in applied settings: A preliminary analysis. Journal of Applied Behavior Analysis, 13, 595–609. Mitchell, W. S., & Stoffelmayr, B. E. (1973). Application of the Premack principle to the behavioral control of extremely inactive schizophrenics. Journal of Applied Behavior Analysis, 6, 419–423. Mithaug, D. E., & Mar, D. K. (1980). The relation between choosing and working prevocational tasks in two severely retarded young adults. Journal of Applied Behavior Analysis, 13, 177–182. Premack, D. (1963). Rate differential reinforcement in monkey manipulation. Journal of the Experimental Analysis of Behavior, 6, 81–89. Premack, D. (1970). A functional analysis of language. Journal of the Experimental Analysis of Behavior, 14, 107–125. Premack, D., & Bahwell, R. (1959). Operant-level lever pressing by a monkey as a function of interest interval. Journal of the Experimental Analysis of Behavior, 2, 127–131. Premack, D., & Premack, A. J. (1963). Increased eating in rats deprived of running. Journal of the Experimental Analysis of Behavior, 6, 209–212. Premack, D., & Schaeffer, R. W. (1962). Distributional properties of operant-level locomotion in the rat. Journal of the Experimental Analysis of Behavior, 5, 89–95. Premack, D., & Schaeffer, R. W. (1963). Some parameters affecting the distributional properties of operant-level running in rats. Journal of the Experimental Analysis of Behavior, 6, 473–475. Premack, D., Schaeffer, R. W., & Hundt, A. (1964). Reinforcement of drinking by running: Effect of fixed ratio and reinforcement time. Journal of the Experimental Analysis of Behavior, 7, 91–96.

SME FUNCTIONS: TOLERANCE TRAINING OPTION (OR DIFFERENTIAL NEGATIVE REINFORCEMENT OF ALL OTHER BEHAVIORS) Brief Description In tolerance training or differential negative reinforcement of other behavior (DNRO), the specific maintaining reinforcer is contingent on the absence of the target behavior in a given period of time. In this case, the maintaining reinforcer is the avoidance or termination of an event, item, or person that is aversive to the client. DNRO is one of the simplest of all behavior reduction procedures. One could also view a DNRO as a reinforcement system that allows the person to escape or avoid a specific negative reinforcer by engaging in a variety of behaviors, as long as the targeted behavior does not occur.

To implement a DNRO program, the staff, parent, or teacher determines if the target behavior occurred during a specified interval of time. If it occurred, escape or avoidance is prevented, and the interval is reset for the full DNRO period. If the target behavior did not occur, reinforcement in the form of termination of an unpleasant event or task is provided at the end of the designated interval. By providing reinforcement in this way, engaging

6 Functional Behavioral Treatment Protocols for SME 4.0: Problem Behaviors 265

in any behavior other than the targeted behavior pays off better. Concurrently, the target behavior’s functional relation to escape or avoidance of an aversive event is disabled.

The advantage of using a DNRO procedure is that it is easy to implement, and it specifically focuses on the reduction of the unwanted behavior. It is not designed to teach any new behavior or to target any specific behavior for an increase. Differential reinforcement has been one of the most widely used procedures for dealing with the reduction of unwanted behaviors.

Terms Interbehavior interval: The length of time that passes between the end of one targeted behavior

and the beginning of the next occurrence of the targeted behavior. DNRO interval: The length of time the person must abstain from engaging in the target

behavior in order to escape or avoid the aversive event. Thinning the schedule of delivery of maintaining reinforcer: The process of gradually

increasing the time that elapses before the negative reinforcer is removed. Escape: Engaging in behavior that terminates the presence of an aversive task or event. Avoidance: Engaging in behavior that prevents one from coming in contact with an aversive

task or event. Aversive stimulus: A task, event, or person that, when presented, evokes a response that avoids

or escapes the stimulus.

Apparatus Timing device—This can be a kitchen timer, alarm clock, computer with alarm feature, and

so on. A tape recorder with beeps at designated intervals, or a calendar, depending on the length of the schedule of NCR. Its purpose is to prompt the staff person, teacher, or parent to remove the aversive event.

Data sheets—See Form 6.3 “Simple Frequency Data With Formulas”

Baseline Measurement 1. Identify the target behavior to be observed. 2. Operationally define or pinpoint the behavior being observed, with specific criteria

for onset and offset of behavior (if not readily evident). 3. Determine the observation period, possibly reviewing scatter plot or A-B-C data to

identify periods of time when behavior is highly likely. 4. Construct the data sheet to reflect the length of the observation period, trying to keep

the length reasonably similar in multiple baseline sessions. 5. During observation, record the occurrence of the target behavior. 6. Repeat step 5 until the observation period ends. 7. Sum the total number of occurrences of the target behavior, and enter that number

on the data sheet. 8. Divide the session length by the total frequency of target behavior (see following

examples) to arrive at the interbehavior interval for that session. 9. Complete at least four more baseline sessions. 10. Graph or display the interbehavior interval across all baseline sessions, noting the

range and mean.

Calculating the Interbehavior Interval. Suppose we had the data in Table 6.3 and wanted to determine the interbehavior interval.

266 Functional Behavioral Assessment, Diagnosis, and Treatment

To calculate the interbehavior interval for the entire 5 days of observation, simply take the total number of minutes for observations, and divide the number by the total number of occurrences of the target behavior. In this case:

600 total minutes ÷ 18 total occurrences of behavior = an interbehavior interval of 33.33 minutes.

If we were to calculate the interbehavior interval for Day 1, it would be:

120 minutes ÷ 2 occurrences of behavior = an interbehavior interval of 60 minutes.

If we were to calculate the interbehavior interval for Day 5, it would be:

120 minutes ÷ 6 occurrences of behavior = an interbehavior interval of 20 minutes.

DNRO With Extinction Procedures 1. From baseline data, calculate the interbehavior interval. 2. Determine the schedule for the removal of the negative reinforcer. The initial

schedule should be set so that removal of the negative reinforcer occurs at or more frequently than the average interbehavior interval; for example, initial interval set at 20% below the average interbehavior interval. (An average interbehavioral interval 33 minutes times 80% would equal 26.4 minutes.) This becomes the DNRO interval length.

3. Set the timing device to the initial removal schedule. 4. When the timer goes off, terminate the negative reinforcer if the person has not

engaged in the target behavior for the entire time period, and then reset the timer. 5. As soon as the client engages in the target behavior during the interval, do not allow

escape or avoidance of the aversive event; use extinction procedures as needed, and reset the timer for the full DNRO interval.

6. Thin the schedule of the negative reinforcement.

Thinning the Schedule of Removal of the Negative Reinforcer

When the target behavior goal is achieved, increase the length of the DNRO interval and set a new target behavior goal. The steps for thinning the schedule follow.

1. When the target behavior goal is achieved, increase the DNRO interval by 5% to 10%. For example, if the DNRO interval was 5 minutes, and the target behavior goal was met, then the new schedule for removal might be set at 5 minutes, 30 seconds.

2. With each week of success in achieving the target behavior goal, the schedule of removal is thinned by progressively increasing the DNRO interval by 10%.

TABLE 6.3 n INTERBEHAVIOR INTERVAL DATA

Behavior: Hitting Total Observation Time: 600 min (1, 120-minute session per day) Session Length: 120 min Number of Days: 5

1 2 3 4 5 Totals

Hitting xx xxx xxxxx xx xxxxxx 18

Interbehavior interval 60 min 40 min 24 min 60 min 20 min 33.33 min

6 Functional Behavioral Treatment Protocols for SME 4.0: Problem Behaviors 267

3. If the target behavior occurs at a rate consistently higher than the established goal over a given week, consider returning to the previous DNRO interval.

4. If you have made several attempts at thinning the schedule but are unable to get past a particular DNRO interval, it may be best to keep the schedule at that level while incorporating another functional treatment program.

If utilizing this behavior option for direct escape (DE) behaviors: Utilize the same baseline and treatment procedures as above, except that chain interruption would occur instead of extinction when the target behavior is displayed.

How It Works As with all differential reinforcement, DNRO works by altering the contingencies such that engaging in the target behavior reduces the frequency and magnitude of reinforcement. Prior to the DNRO contingency, the exhibition of the target behavior was functional. The social environment enabled such a behavior by frequently removing the negative reinforcer contingent upon its occurrence. The DNRO schedule disables this function by further postponing the removal of the aversive event contingent on an occurrence of the target behavior, that is, the DNRO interval is reset. Therefore, doing anything other than the target behavior is a more efficient path to escape or avoid the aversive event.

Hypothetical Example

The 20-Minute Child. Fred was an elementary school student in a regular education classroom. Mr. Delgadillo received a referral to develop a plan to reduce the disruptive desk hitting of Fred. Mr. Delgadillo was not sure what was maintaining the desk-hitting behavior, so he decided to set up an A-B-C chart, and he collected data for a 2-week period. A sample of the data collected is presented in Table 6.4.

TABLE 6.4 n SUMMARY OF DESK-HITTING A-B-C DATA

Antecedent Conditions

Target Behavior What Happened? What Was Natural Result of Behavior?

1. Seated in desk, working on math.

Hit desk with open hand with enough force for it to be audible outside the classroom.

Teacher goes to desk and talks with Fred regarding disrupting class.

Sensation produced when striking desk and sound produced.

2. Seated in desk, working on reading.

Hit desk with open hand with enough force for it to be audible outside the classroom.

Teacher goes to desk and talks with Fred regarding disrupting class.

Sensation produced when striking desk and sound produced.

3. Seated in desk, taking math test.

Completed math test. Sat quietly while others finished taking test.

Praise from teacher for doing well.

Inconsequential.

4. Seated in desk, free period.

Did various tasks, no one longer than 5 minutes.

Praise from the teacher for doing well.

Inconsequential.

5. Sitting in desk, prompted to begin reading.

Took out book and began to read.

Teacher ended reading period after 10 minutes due to an assembly.

Inconsequential.

268 Functional Behavioral Assessment, Diagnosis, and Treatment

After examining the previous A-B-C descriptive data, Mr. Delgadillo set about answering the questions: “What are the common elements in the events involving desk hitting?” and “How do they differ from the events that did not produce desk hitting?” Mr. Delgadillo discovered Fred did not engage in desk hitting when he was working on tasks of his choice, even if no one interacted with him for periods as long as 45 minutes, which ruled out SMA 2.1: Adult Attention and SMA 2.2: Peer Attention as the likely maintaining function. Desk hitting was never followed by the presentation of a tangible item eliminating a hypothesis of SMA 2.3: Tangible Reinforcer as a maintaining function. Mr. Delgadillo noticed that desk hitting happened only if Fred worked on a task, not of his choosing, for greater than 15 minutes without a break. After an event of desk hitting was interrupted by the teacher, Fred would typically stop work on the undesired task for an average of 5 minutes while the teacher corrected his behavior. Fred would then sometimes be offered a different, more preferred task on which to work.

Mr. Delgadillo determined the most likely hypothesis is that desk hitting is being maintained by 4.2 SME: Relatively Lengthy Tasks/Chores/Assignments (see Table 6.5). Having formulated a hypothesis, Mr. Delgadillo collected data during a 4-hour session (240 minutes) each day for 5 days. The data indicated that Fred was hitting the desk at a rate of about three times per hour (see Example Form 6.3).

The interbehavior interval was calculated by determining

Total minutes observed (1,200 minutes) ÷ Total frequency target behavior occurred (58 occurrences) = Average interbehavior interval (20.7 minutes).

With this data in hand, and an understanding of the function of the desk-hitting behavior, Mr. Delgadillo formulated an intervention plan (see Example Form 6.4). Because the problem was not a skills deficit and really required just changing the contingencies to increase the length of time Fred was reading, Mr. Delgadillo settled on differential reinforcement. Because the target behavior was maintained by an escape function, Mr. Delgadillo decided to use tolerance training (DNRO). Having determined that the desk-hitting behavior occurred about every 20 minutes, he set the initial DNRO interval to 15 minutes to ensure that Fred was very likely to obtain reinforcement more often under this plan.

Prior to implementing the program, Mr. Delgadillo informed the staff that an extinction burst would probably occur and that they should be prepared for this event. He also made sure to be in the classroom during the implementation of the program so that he could support the teaching staff and assure them that the program was implemented correctly. The program was implemented, and the following data were collected and are presented in Figure 6.2.

As Mr. Delgadillo expected and as can be seen in the graph, the DNRO was successful in reducing the occurrence of desk-hitting behavior. It is interesting to note that as

TABLE 6.5 n DIAGNOSTIC TABLE FOR DESK HITTING

Diagnosis 4.2 SME: Relatively Lengthy Tasks/Chores Assignments

Target behavior(s): Desk hitting

Function: Escape a reading task after greater than 15 minutes of continuous reading

Target behavior likely under following contexts: Reading for time periods exceeding 15 minutes

Target behavior unlikely under following contexts:

Free time or working on tasks other than reading

Rule out: SMA 2.1: Adult Attention SMA 2.2: Peer Attention SMA 2.3: Tangible Reinforcer

SMA, socially mediated access; SME, socially mediated escape.

6 Functional Behavioral Treatment Protocols for SME 4.0: Problem Behaviors 269

Example of From 6.3 n Frequency Count Data Sheet

• Client: Fred Chart Started: 6-21

Day/Month/Year

• Behavior: Desk Hitting

• Total Observation Time: 1200 min (1, 240-minute session/day) Session Length: 240 min

• Number of Days: 5

A. Total minutes observed: 1,200 Interbehavior interval = A/B 1,200/58 = 20.69 min Rate/hour = (B/A)60 (58/1,200)60 = 2.9/hr

1 2 3 4 5 Totals

Desk hitting

xxxxxxx xxxxxxxxxxx xxxxxxxxxxxxx xxxxxxxxxxxxxxx xxxxxxxxxxx 58

Daily rate

1.75/hr 2.75/hr 3.25/hr 4/hr 2.75/hr 2.9/hr

Inter- behavior Interval

34.29 min 21.82 min 18.46 min 15.00 min 21.82 min 20.69 min

Mr.  Delgadillo predicted, on 6/25, the desk hitting behavior worsened. This is a familiar and expected pattern when using extinction, called an extinction burst. Following this burst (increase in rate from prior level), the desk-hitting behavior steadily and quickly declined. Because Mr. Delgadillo had let the teaching staff know what to expect, they were prepared for this and stuck with the plan. By 7/14 the behavior had met the criteria for thinning the DNRO schedule, so Mr. Delgadillo increased the interbehavior interval by 10% such that reinforcement was now delivered every 17 minutes. Mr. Delgadillo continued this thinning process until the desk-hitting behavior was no longer occurring.

What If?

What if the behavior does not decrease (or gets worse) with DNRO?

When using DNRO with extinction, we often see an initial worsening of the target behavior. The technical term for this is an extinction burst. Just like its name implies, it is a brief and often intense increase in the target behavior that happens when the behavior no longer produces the reinforcer. You should see a dramatic decrease in the behavior within 3 sessions or days. If the behavior continues at a high rate for longer than that, you will need to confirm that the item or event you are removing contingently is actually reinforcing for the person. The other possibility is that the DNRO interval is simply too long for the person to contact the reinforcer at a high enough rate to reinforce other behaviors. In this case, shortening the DNRO interval is an option you should consider. If this is still ineffective, you should consider a more focused reinforcement strategy, perhaps starting with NCR.

What if I cannot ignore some of the target behaviors?

If the target behavior has life-threatening consequences or cannot be ignored, you can program a DNRO without extinction. In this case, all the elements of the DNRO would be the same with the exception that when the target behavior occurs, we will continue to respond

270 Functional Behavioral Assessment, Diagnosis, and Treatment

Example Form 6.4 n Tolerance Training Or Differential Negative Reinforcement With Extinction: Plan

• Person served: Fred

• Target behavior: Desk hitting

• Behavioral diagnostic category: SME 4.2: Task Duration

• Target rate: 0 events per week

• Designated time period(s): All class periods

• Baseline data across five times/sessions: 1. 7

2. 11

3. 13

4. 16

5. 1

• Intervals with no occurrence of desk hitting:

l° Rate of target behavior Baseline: 2.9/hour Target: 0 l° Interbehavior interval Baseline: 20.7 min Target: 24 hours

• Initial schedule of differential negative reinforcement:

l° X Fixed time schedule every 15 minutes/hours/days

OR

l° __Variable time schedule on average every__minutes/hours/days

• Reset timer: End of each interval

l° X End of each interval AND if target behavior occurs

• Reinforcer(s) to be used: 1. Stop current task and give a short break (5 min)

2.

3. 4. 5.

l° Special instructions for delivery of reinforcer(s):

1. If desk hitting occurs, immediately reset the timer to 15 minutes and record data.

2. Reset timer to 15 minutes at the end of the earned 5-minute break.

• Criterion for increasing amount of time between reinforcers: When desk-hitting behavior occurs in <1% of intervals observed for 3 consecutive days, increase time between delivery of reinforcement by 10%.

• Criterion for decreasing amount of time between reinforcers: If desk-hitting behavior occurs in more than 5% of observed intervals for 3 consecutive days, decrease time between delivery of reinforcement by 1 minute.

• Criterion for withholding the scheduled reinforcer delivery: Occurrence of desk hitting.

to it as we have in the past. This will make the behavior change process somewhat slower because the difference in level of reinforcement will not be as great. This can be countered to some extent by shortening the DNRO interval, thus increasing the density of reinforcement for all other behaviors.

6 Functional Behavioral Treatment Protocols for SME 4.0: Problem Behaviors 271

FIGURE 6.2 n Frequency of desk hitting.

60

Frequency of Desk Hitting Per Day

50 Frequency of Desk Hitting

40

30

Days

20

10

0

6/ 25

7/ 13

7/ 12

7/ 11

7/ 107/

9 7/

8 7/

7 7/

6 7/

5 7/

4 7/

3 7/

2 7/

1 6/

30 6/

29 6/

28 6/

27 6/

26 7/

14

70

Forms: DNRO

6.3 Simple Frequency Data With Formulas 6.4 DNRO With Extinction: Simple Plan 6.5 Formulas for Calculating Percentage of Intervals of Targeted Behavior and

Interbehavior Intervals 6.6 Formulas for Determining Increases or Decreases in Frequency of Differential Negative

Reinforcement

272 Functional Behavioral Assessment, Diagnosis, and Treatment

Form 6.3 n Simple Frequency Data With Formulas

• Client:________________ Chart Started:________________

Day/Month/Year

• Behavior:

• Total Observation Time: min (__, ___-minute session/day) Session Length: min

• Number of Days:

• Place an X on the appropriate day box each time the target behavior occurs

A. Total minutes observed: Interbehavior interval = A/B / = ____ • Rate/hour = (B/A)60 ( / ) 60 = ____

A. Total minutes observed:___Interbehavior interval = A/B / = ____ B. Total occurrences observed:____

C. Range (low) to (high)___, Avg = Rate/hour = (B/A)60 ( / )60 = ____

8 9 10 11 12 13 14 Totals

Target behavior

Daily rate

Interbehavior interval

1 2 3 4 5 6 7 Totals

Target behavior

Daily rate

Interbehavior interval

6 Functional Behavioral Treatment Protocols for SME 4.0: Problem Behaviors 273

Form 6.4 n DNRO with Extinction: Simple Plan

• Person served:

• Target behavior:

• Behavioral diagnostic category:

• Target rate:

• Designated time period(s):

• Baseline data across five times/sessions: 1. ________

2. ________

3. ________

4. ________

5. ________

• Rate of target behavior: Baseline________ Target _________

• Interbehavior interval: Baseline________ Target _________

• Initial schedule of differential negative reinforcement:

l° ____Fixed time schedule every____ minutes/hours/days

OR

l° ____Variable time schedule on average every _____ minutes/hours/days

• Reset timer:

l° ____End of each interval

l° ____End of each interval AND if target behavior occurs

• Reinforcer(s) to be used: (item or event to be removed or avoided) 1. ________

2. ________

3. ________

4. ________

5. ________

l° Special instructions for delivery of reinforcer(s):

• Criterion for increasing amount of time between reinforcers:

• Criterion for decreasing amount of time between reinforcers:

• Criterion for withholding the scheduled reinforcer delivery:

274 Functional Behavioral Assessment, Diagnosis, and Treatment

Form 6.5 n Formulas for Calculating Percentage of Intervals of Targeted Behavior and Interbehavior Interval

• Interbehavior interval: This formula will help you determine on average how much time passes between the occurrence of targeted behaviors (interbehavior interval).  Use this information to help set the frequency of differential negative reinforcement.

l° Total minutes observed ÷ Total behavior occurrences observed = Average interbehavior interval

• Rate: This formula will help you to determine how often the behavior occurs in a given amount of time. Use this formula if you have different lengths of observation periods to allow for ongoing comparison of data.

l° Number of occurrences of behavior ÷ Length of observation in minutes = Rate of behavior per minute

l° Rate per hour = (rate per minute)60 l° Rate per day = (rate per minute)1,440

Form 6.6 n Formulas for Determining Increases or Decreases in Frequency of Differential Negative Reinforcement

• Formula for 10% increase in DNRO interval (time between negative reinforcement).

Current reinforcement interval × 1.10 = (10% increase in time).

• Formula for 5% increase in DNRO interval.

Current reinforcement interval × 1.05 = (5% increase in time).

• Formula for 10% decrease in DNRO interval.

Current reinforcement interval × 0.90 = (10% decrease in time).

• Formula for 5% decrease in DNRO interval.

Current reinforcement interval × 0.95 = (5% decrease in time).

ADDITIONAL RESOURCES Barton, L. E., Brulle, A. R., & Repp, A. C. (1986). Maintenance of therapeutic change by momentary DRO. Journal of Applied Behavior Analysis, 19, 277–282. Conyers, C., Miltenberger, R., Maki, A., Barenz, R., Jurgens, M., Sailer, A., & Kopp, B. (2004). A comparison of response cost and differential reinforcement of other behavior to reduce disruptive behavior in a preschool classroom. Journal of Applied Behavior Analysis, 37, 411–415. Cowdery, G. E., Iwata, B. A., & Pace, G. M. (1990). Effects and side effects of DRO as treatment for self-injurious behavior. Journal of Applied Behavior Analysis, 23, 497–506. Goetz, E. M., Holmberg, M. C., & LeBlanc, J. M. (1975). Differential reinforcement of other behavior and noncontingent reinforcement as control procedures during the modification of a preschooler’s compliance. Journal of Applied Behavior Analysis, 8, 77–82. Haring, T. G., & Kennedy, C. H. (1990). Contextual control of problem behavior in students with severe disabilities. Journal of Applied Behavior Analysis, 23, 235–243.

6 Functional Behavioral Treatment Protocols for SME 4.0: Problem Behaviors 275

Harris, S. L., & Wolchik, S. A. (1979). Suppression of self-stimulation: Three alternative strategies. Journal of Applied Behavior Analysis, 12, 185–198. Heard, K., & Watson, T. S. (1999). Reducing wandering by persons with dementia using differential reinforcement. Journal of Applied Behavior Analysis, 32, 381–384. Lindberg, J. S., Iwata, B. A., Kahng, S., & DeLeon, I. G. (1999). DRO contingencies: An analysis of variable-momentary schedules. Journal of Applied Behavior Analysis, 32, 123–136. Luce, S. C., Delquadri, J., & Hall, R. V. (1980). Contingent exercise: A mild but powerful procedure for suppressing inappropriate verbal and aggressive behavior. Journal of Applied Behavior Analysis, 13, 583–594. Marcus, B. A., & Vollmer, T. R. (1996). Combining noncontingent reinforcement and differential reinforcement schedules as treatment for aberrant behavior. Journal of Applied Behavior Analysis, 29, 43–51. Martinez, S. S. (1977). Comparison of extinction, DRO 0-sec, and DRO 6-sec in the elimination of imitative responding under discrete-trial paradigms. Journal of Applied Behavior Analysis, 10, 315. Mazaleski, J. L., Iwata, B. A., Vollmer, T. R., Zarcone, J. R., & Smith, R. G. (1993). Analysis of the reinforcement and extinction components in DRO contingencies with self-injury. Journal of Applied Behavior Analysis, 26, 143–156. McCord, B. E., Iwata, B. A., Galensky, T. L., Ellingson, S. A., & Thomson, R. J. (2001). Functional analysis and treatment of problem behavior evoked by noise. Journal of Applied Behavior Analysis, 34, 447–462. Piazza, C. C., Fisher, W. W., Hanley, G. P., Hilker, K., & Derby, K. M. (1996). A preliminary procedure for predicting the positive and negative effects of reinforcement-based procedures. Journal of Applied Behavior Analysis, 29, 137–152. Repp, A. C., Barton, L. E., & Brulle, A. R. (1983). A comparison of two procedures for programming the differential reinforcement of other behaviors. Journal of Applied Behavior Analysis, 16, 435–445. Repp, A. C., & Deitz, S. M. (1974). Reducing aggressive and self-injurious behavior of institutionalized retarded children through reinforcement of other behaviors. Journal of Applied Behavior Analysis, 7, 313–325. Rolider, A., & Van Houten, R. (1985). Movement suppression time-out for undesirable behavior in psychotic and severely developmentally delayed children. Journal of Applied Behavior Analysis, 18, 275–288. Thompson, R. H., Iwata, B. A., Hanley, G. P., Dozier, C. L., & Samaha, A. L. (2003). The effects of extinction, noncontingent reinforcement, and differential reinforcement of other behavior as control procedures. Journal of Applied Behavior Analysis, 36, 221–238. Vollmer, T. R. (1999). Noncontingent reinforcement: Some additional comments. Journal of Applied Behavior Analysis, 32, 239–240. Vollmer, T. R., Iwata, B. A., Zarcone, J. R., Smith, R. G., & Mazaleski, J. L. (1993). The role of attention in the treatment of attention-maintained self-injurious behavior: Noncontingent reinforcement and differential reinforcement of other behavior. Journal of Applied Behavior Analysis, 26, 9–21. Woods, D. W., & Himle, M. B. (2004). Creating tic suppression: Comparing the effects of verbal instruction to differential reinforcement. Journal of Applied Behavior Analysis, 37, 417–420.

276 Functional Behavioral Assessment, Diagnosis, and Treatment

SME FUNCTIONS: ESCAPE MAND (PROTEST OR NEGOTIATING BEHAVIOR) OPTION Brief Description In this replacement function option, the removal of the negative reinforcer, whether it be aversive tasks, events, or people, occurs upon an appropriate mand (request) from the client. Concurrently, the target behavior no longer functions to efficiently escape the aversive event, that is, programmed extinction. This is an application of differential reinforcement, specifically differential negative reinforcement of an alternative behavior (DNRA). In this option, the alternative behavior is a request (mand) to terminate, or a protest of, the conditions that are aversive to the client.

To implement an escape mand replacement behavior program for a problem behavior that is diagnosed with an SME function, you determine what specific form the request or protest should take. Such a form will result in the contingent removal of a negative reinforcer (escape or avoidance). In the beginning part of this program, each time the new request or protest behavior occurs, it must result in removing the negative reinforcer. If the target behavior occurs, it should result in the loss of opportunity to escape or avoid the aversive event (extinction) until the protesting behavior is utilized. By removing the negative reinforcer only if the person uses the specified protesting behavior, the specified replacement behavior “pays off ” better than the target behavior.

The advantage of using this procedure is that it teaches a specific behavior that will result in the removal of a negative reinforcer when the person is most motivated to escape or avoid that particular negative reinforcer. This makes the acquisition of the skill relatively rapid and generally results in a robust response that can be shaped and generalized to overcome other target behaviors. A disadvantage of this option involves an initial interruption in the client’s routine due to a parent or staff person immediately complying with the person’s request to escape or avoid the aversive stimulus. This option is a bit more labor intensive than DNRO and requires a higher level of expertise and interaction on the part of the people implementing the intervention.

Terms Mand: A verbal operant behavior under the control of a specific motivating operation that

produces a socially mediated specific reinforcer (in the case of a negative reinforcer, a request to escape or avoid).

Escape: Engaging in behavior that terminates the presence of an aversive task or event. Avoidance: Engaging in behavior that prevents one from coming in contact with an aversive

task or event. Aversive stimulus: A task, event, or person to which the person will make a response that

avoids or terminates the stimulus.

Apparatus Data sheets—See Form 6.7 “Simple Frequency Data on Target and Replacement Behavior”

Baseline Measurement It is important to first determine the form of the protesting behavior that will be developed or increased prior to baseline data collection. Next, you can collect baseline data on both the target behavior and the replacement behavior using Form 6.7.

If the frequency of the target behavior is low, you might consider using a trigger analysis, that is, contriving an antecedent condition that causes the person to encounter the aversive task, event, or person, and observe what behavior occurs (target or replacement behavior).

6 Functional Behavioral Treatment Protocols for SME 4.0: Problem Behaviors 277

See “trigger analysis” in Chapter 2 for greater detail on conducting this assessment. Realize that the conditions of aversive stimulation have to be present in order for either behavior to occur. Try to make sure that no one, in any way, removes or reduces the aversive conditions prior to the end of your assessment.

Procedures 1. Present the person with a nonpreferred task, object, or activity (e.g., a wash cloth,

least preferred math task, or food item the person dislikes) with instruction (e.g., “Here, have this.” Or “Do this.”).

2. After a short time delay (0–2 seconds), provide a general prompt, “What’s wrong?” 3. Reinforce a desired protest response (either handing back object or saying or signaling

“No!”). 4. If the identified form of the replacement response is vocal and a vocal protest response

does not occur to the general prompt, or if the target behavior occurs, model vocal protest (e.g., “stop,” “no,” “I do not want to do that,” or “I don’t want that”).

5. If the identified form of the replacement response is nonvocal and a nonvocal protest response does not occur to general prompt, or if the target behavior occurs, physically guide the protest response, either handing back the object or manually signing “no” or “stop.”

6. Reinforce any approximation of the desired form of protest (vocal or nonvocal) by removing the nonpreferred object or stopping the activity and initiating a more preferred activity. Do not allow the target behavior to result in the removal of the nonpreferred item or activity (escape extinction).

7. During subsequent protest opportunities, provide less guidance (or modeling) of the protest response until it occurs independently and immediately at the presentation of the nonpreferred task, object, person, or activity.

8. Utilize many different nonpreferred activities and objects during structured training sessions to teach a generalized skill of protesting.

9. Consider developing a Requesting Behavior Option Plan in conjunction with this skill. 10. Provide opportunities for protesting behaviors in real life by occasionally handing

the client a nonpreferred item or engaging the person in a nonpreferred activity. Reinforce protest with removal of nonpreferred item or activity.

Capturing Motivation—It is essential that the person being assessed is motivated to escape or avoid the task, event, or person. The judgment of when the person wants to avoid or escape the task, event, or person can generally be along the same conditions under which the SME target behavior occurred. Using this same level of aversive stimulation that existed as a motivating condition for the problem behavior, you now use the above procedures to develop the replacement behavior.

Modification for Use with DE Behaviors. 1. Utilize the same baseline measurement procedures. 2. When the target behavior occurs, use chain interruption procedures and follow the

Escape Mand Replacement Behavior Option instructions starting with step 4 as listed previously.

How It Works Teaching a protesting behavior (mand) works by establishing an alternate form of behavior that will allow the person to more effectively and efficiently escape or avoid the same maintaining negative reinforcer as the target behavior. By ensuring that the alternate behavior “pays off ” better for the person, the function of alternative behavior is enabled and

278 Functional Behavioral Assessment, Diagnosis, and Treatment

the function of the target behavior is disabled. Once the person has an alternative behavior in his or her repertoire that can function as a protest, you enable its function by making it more effective and efficient than the target behavior in removing the negative reinforcer. Once the mand is functional, the fading or thinning process allows for the natural contingencies in the environment to control the protesting behavior so that it will maintain over time.

Hypothetical Example

“I’m Bored” As an example, let us look at how the Escape Mand Replacement Behavior Option might

be applied to the case of the child who learned how to get a 5-minute break by throwing things in class.

Mr. Jones, a behavior analysis consultant, was told by the teaching staff that once or twice a day, for no apparent reason, Susan would get out of her seat, grab an item off of her desk or someone else’s desk, and throw it as hard as she could against the wall. Staff contended that the problem behaviors were occurring “for no good reason” and just came “out of the blue.” The staff commented that it was probably due to some mental illness. Given the variability and lack of specific information in staff reports, Mr. Jones needed to find a way to obtain reliable information. He decided to perform a descriptive functional assessment (A-B-C analysis) from his direct observations. Table 6.5 summarizes his findings.

Mr. Jones reviewed his observations. He noted that the behavior occurred only after Susan had been working on a task for over 20 minutes. Although Susan’s throwing behavior produced attention from the teacher, she engaged in other behaviors that were equally successful in getting teacher attention. Mr. Jones noted that throwing objects also resulted in Susan’s removal from the assignment for a period of time. This finding ruled out SMA 2.1: Staff Attention as the maintaining contingency for the throwing behavior. The sensory result of throwing items did not appear to be the purpose of the behavior, given the relative infrequency of such behavior and that it was more likely to occur when working on an assignment for relatively long periods of time. Further, Susan appeared happy or excited by the prospect of being sent to time-out. Mr. Jones also noticed that Susan was compliant with demands to complete short duration tasks.

Mr. Jones concluded that the most likely maintaining contingency was SME 4.2: Relatively Lengthy School Assignments (see Table 6.6). Currently, Susan’s throwing of items is frequently followed by being removed from the school work task for at least 5 minutes.

TABLE 6.5 n SUMMARY OF THROWING ITEMS A-B-C DATA

Antecedent Conditions

Target Behavior

What Happened? What Was Natural Result of Behavior?

1. Independent seat work, math problems.

Throwing things.

Teacher prompted Susan to step into the hallway and counseled her about her behavior. Susan was apologetic and talkative. Returned to seat work after discussion.

Material landing on the floor; visual/ auditory effect.

2. Independent seat work, vocabulary words.

Throwing things.

Teacher prompted Susan to take a break in the hallway. Susan complied. The teacher prompted her to return in about 5 minutes. Susan went back to her seat work.

Material landing on the floor; visual/ auditory effect.

3. Standardized assessment testing.

Throwing things.

Susan was sent to time-out for 5 minutes. She went willingly and appeared happy to go. After time-out she returned to the testing.

Material landing on the floor; visual/ auditory effect.

6 Functional Behavioral Treatment Protocols for SME 4.0: Problem Behaviors 279

The SME 4.2 diagnosis made perfect sense in regards to why the behavior appeared to occur randomly and only once or twice per day. Susan was willing to engage in school work, but if it continued for too long, she found a way to get a break.

Mr. Jones considered using DNRO, tolerance training; however, this student could already stay on task for an acceptable length of time, and during his observations he had never observed Susan making a request of the teacher. Mr. Jones decided to train a requesting behavior using DNRA. This would result not only in a reduction of throwing things, but also would develop a skill that could be used to effectively escape many aversive situations in the school setting.

Prior to writing the plan, Mr. Jones requested that the teacher record baseline data on the frequency of throwing things and the frequency of requesting a break across 55-minute-long observation sessions over 6 days. The data was recorded on Example Form 6.7.

With this frequency data in hand and an understanding of the function of the throwing behavior, Mr. Jones formulated an intervention plan (see Example Form 6.8). He determined that throwing things occurred under the conditions of having been working continuously on a seat work task for over 20 minutes. His data also indicated that the student very rarely exhibited the replacement behavior of requesting a break, and when the request was made it did not result in getting a break.

Mr. Jones knew that the targeted behavior of throwing things was more likely around 11:00 a.m. each day, when the student was at her desk and had been doing school work for over 20 minutes. He decided the best way to capture a high level of motivation for the taking a break was to set up training for about 11:00 a.m. in the classroom at the student’s desk after she had been continuously working for at least 20 minutes.

Mr. Jones decided that the protesting behavior he would try to establish was having the student simply pull out a laminated break card, show it to the teacher, and wait for the teacher to acknowledge or approve the request. Susan would then set a timer for 5 minutes of break time. Subsequently, after the break, she would return to work.

Mr. Jones set the initial reinforcement schedule such that every presentation of a break card produced 5 minutes of break time. In order to limit the amount of break time used, Mr. Jones set an additional contingency that if in any period (morning or afternoon) Susan did not go over her allotted number of break cards, she earned five points toward a video of her choice at her parent’s home. She had to earn 30 points by Friday afternoon in order to earn the video (i.e., no more than two periods in the week where she took more than two breaks).

To increase the speed of this process, Mr. Jones also specified another contingency. Specifically, if the student engaged in throwing things, any break cards left were immediately removed for the remainder of the morning or afternoon session. If she continued throwing materials, she would be removed from the area for the protection of other students and placed in time-out until she “calmed down.” Following time-out, she would be told that she

TABLE 6.6 n DIAGNOSTIC TABLE FOR THROWING OBJECTS

Diagnosis SME 4.2: Relatively Lengthy School Assignments

Target behavior(s): Throwing objects.

Function: Terminates her engagement with the task for assignments that last longer than 20 minutes.

Target behavior likely under following contexts: Task duration exceeding 20 minutes.

Target behavior unlikely under following contexts:

Short duration tasks with breaks interspersed.

Rule out: SMA 2.1: Staff Attention SME 4.1: Unpleasant Social Situations

SMA, socially mediated access; SME, socially mediated escape.

280 Functional Behavioral Assessment, Diagnosis, and Treatment

Example Form 6.7 n Frequency Count Data Sheet

• Client: Susan Chart Started:_____________

Day/Month/Year

• Behavior: Throwing things

• Total Observation Time: 330 min (2, 55-minute session/day) Session Length 55 min

• Number of Days: 6

• Place an X on the appropriate day box each time the behavior occurs

A. Total minutes observed: 330

B. Total target behavior occurrences observed: 6

C. Total replacement behavior occurrences observed: 1

Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Totals

Throwing things x x xx x x 6

Requesting a break x 1

had extra work to do during recess at the principal’s office area (reverse Premack). Further, she would not earn five points and would have to return to the assignment during the class period.

Mr. Jones specified that the following prompt sequence should be used in teaching Susan to request a break. The first prompt would be delivered vocally and progress to more helpful or intrusive prompts if the prompt card was not presented. The instructions to the staff were as follows:

1. After at least 20 minutes of seat work, provide the prompt, “Do you want a break?” 2. If no response, provide the same prompt with the addition of a gestural prompt of

pointing to the break card. 3. Once the request via the break card occurs, allow Susan to take a break for 5 minutes.

Mr. Jones also wanted to make sure that Susan would eventually present a break card when she wanted a break from school work without anyone prompting her to do so. In order to accomplish this, he developed a plan for slowly decreasing the prompts that were provided. He determined that once Susan could present a break card with prompts for 3 consecutive days, the staff would be taught to reduce or fade the prompts.

The program was implemented and produced the data displayed in Figure 6.3. As Mr. Jones expected, this plan was successful in reducing the occurrence of throwing behavior and increasing the rate of protesting behavior (mand for a break). By 1/14 the protesting behavior had met the criteria for fading prompts. The prompts were gradually faded until Susan was requesting her break independently.

What If?

What if the behavior does not decrease or gets worse?

When using this option, which is DNRA with extinction, we often see an initial worsening of the target behavior. The technical term for this is an extinction burst. Just like its name implies, it is a brief and often intense increase in the target behavior that happens when the behavior no longer produces termination of the negative reinforcer.

6 Functional Behavioral Treatment Protocols for SME 4.0: Problem Behaviors 281

Example Form 6.8 n Teaching Requesting Behavior: Simple Plan

• Person served: Susan

• Target behavior: Throwing items

• Behavioral diagnostic category: SME 4.2: Lengthy School Assignments

• Protesting/negotiating behavior:

Requesting a break

A. Form of protest: vocal request; manual signed request; requesting by pointing to a communication board; use augmentative device to request; other:

Holding up of break card

B. Description of initial protest to be reinforced: Show one of her break cards to the teacher; wait for acknowledgment, and set the timer for five minutes.

• Reinforcer(s) to be used: Type Amount

1. End task/recess 1. 5 min

2. 2.

• Target rate: No more than four times per day.

• Instructions to assure motivation:

l° Train at Time and place that target behavior is most likely which is: Training in the classroom at her desk after at least 20 minutes of continuous seat work task.

l° Ensure limited escape from the negatively reinforcing item at other times by: Redirecting back to task after throwing behaviors.

• Rate of target behavior: Baseline 1/hr Target 0/day

• Rate of protesting behavior Baseline 1/day Target 2/day

• Initial schedule of differential negative reinforcement:

A. Remove/terminate the unwanted event/item after every 1 (number of) protests and with no more than a 5 sec delay.

• Targeted final schedule of differential negative reinforcement:

A. No more than 2 (number of ) protests in a half day (time period)

• Replacement behavior is reinforced:

l° If the protesting behavior occurs independently, terminate the negative reinforcer.

l° If the protesting behavior does not occur under the targeted conditions, provide the following prompts (using Vocal):

1. Provide the prompt “Do you want a break?”

2. If no response, provide the prompt again with the item break card and timer within sight.

3. If no response, provide the prompt with the addition of a gestural prompt.

4. If no response, provide the prompt with the addition of modeling the response.

5. Once the protest occurs, set the timer and provide a 5-minute break.

6. Repeat up to four times per day (two in the a.m. and two in the p.m.)

(continued )

282 Functional Behavioral Assessment, Diagnosis, and Treatment

• If target behavior occurs:

l° Specifically if Susan engaged in throwing things, any break cards left are immediately removed for the remainder of the morning or afternoon session. If she cannot be stopped from continuing to throw materials, she will be removed from the area for the protection of other students and placed in time-out until she “calms down.” Following time-out, she will be told that she has extra work to do during recess at the principal’s office area (Reverse Premack). Further, she does not earn five points and has to return to the assignment during the class period.

l° Special instructions for delivery of small amount of reinforcer(s): Breaks are to last no longer than 5 minutes and a maximum of four times per day.

• Criterion for fading prompts: When target rate for replacement behavior is reached on 3 consecutive days, reduce the level of helpfulness of the prompt first by waiting for 5 seconds before providing the prompt, and then by reducing the prompt from vocal to simple hand gestures, and eventually  to  the level of prompts that would usually be in place in the classroom.

Example Form 6.8 n Teaching Requesting Behavior: Simple Plan (continued )

FIGURE 6.3 n Breaks and throwing items.

6

7

8

5

4

Fr eq

ue nc

y p

er d

ay

3

2

1

0

Days 1/2 1/201/191/181/171/161/151/141/131/121/111/101/91/81/71/61/51/41/3 1/21

Throwing Items Break request

You should see a dramatic decrease in the behavior within 3 sessions or days. If the behavior continues at a high rate for longer than that, you will need to confirm that the behavior you have set up as the protesting behavior is actually resulting in termination of the negative reinforcer. You should also ensure that extinction is indeed occurring for the target behavior.

6 Functional Behavioral Treatment Protocols for SME 4.0: Problem Behaviors 283

What if the person is asking to escape all the time?

If the protesting behavior becomes too frequent, you can set up some limits and incentives as described in the example. That is, you can decrease the number of requests that will be honored over time. To do this, you will need to set up an additional contingency to differentially reinforce lower rates of requesting behavior. This is the same basic differential reinforcement process, but you provide reinforcement contingent on the target behavior occurring below a specific standard. You then progressively set the standard at a lower rate.

What if the person has never been observed to have exhibited a request or protest behavior?

In this case, you will have to first teach a behavior that can be used effectively to protest the presentation of some negative reinforcer. This generally involves a task analysis and some specific teaching procedures to ensure that the skill is well established in the client’s repertoire. Discrete Trial Training and Precision Teaching are specific teaching procedures that have been used effectively for this purpose.

Forms: DNRO

6.7 Simple Frequency Data on Target and Replacement Behavior 6.8 Teaching Requesting Behavior: Simple Plan

Form 6.7 n Simple Frequency Data on Target and Replacement Behaviors

• Client: _________________ Chart Started: ______________

Day/Month/Year

• Behavior:

• Total Observation Time: min (__, ___-minute session/day) Session Length: min

• Number of Days:___

• Place an X on the appropriate day box each time the behavior occurs

8 9 10 11 12 13 14 Totals

Target behavior

Replacement behavior

1 2 3 4 5 6 7 Totals

Target behavior

Replacement behavior

(continued )

15 16 17 18 19 20 21 Totals

Target behavior

Replacement behavior

284 Functional Behavioral Assessment, Diagnosis, and Treatment

A. Total minutes observed:

B. Total target behavior occurrences observed:

C. Total replacement behavior occurrences observed:

22 23 24 25 26 27 28 Totals

Target behavior

Replacement behavior

29 30 31 1 2 3 4 Totals

Target behavior

Replacement behavior

Form 6.8 n Teaching Requesting Behavior: Simple Plan

• Person served:

• Target behavior:

• Behavioral diagnostic category:

• Protesting/negotiating behavior:

A. Form of protest: vocal request; manual signed request; requesting by pointing to a communication board; use augmentative device to request; other:

B. Description of initial protest to be reinforced:

• Reinforcer(s) to be used: Type Amount

1. ____________ 1. ____________

2. ____________ 2. ____________

3. ____________ 3. ____________

4. ____________ 4. ____________

5. ____________ 5. ____________

(continued )

Form 6.7 n Simple Frequency Data on Target and Replacement Behaviors (continued )

6 Functional Behavioral Treatment Protocols for SME 4.0: Problem Behaviors 285

• Target rate:

• Instructions to ensure motivation:

l° Train at time and place that target behavior is most likely, which is:

l° Ensure limited escape from the negatively reinforcing item at other times by:

• Designated time period(s) to implement:

• Rate of target behavior: Baseline ____________ Target ____________

• Rate of protesting behavior Baseline ____________ Target ____________

• Initial schedule of differential negative reinforcement:

• Targeted final schedule of differential negative reinforcement:

• No more than (number of ) protests in a (time period):

• Replacement behavior is reinforced:

l° If the requesting behavior occurs independently, terminate the negative reinforcer.

l° If the protesting behavior does not occur under the targeted conditions, provide the following prompts (using Vocal Sign Gesture Visual):

1. Provide the prompt, “What do you want?”

2. If no response, provide the prompt with the addition of a gestural prompt.

3. If no response, provide the prompt with the addition of modeling the response.

4. If no response, provide the prompt with the addition of a physical prompt.

5. If no response, provide increasing physical prompt using least to most prompting.

6. Once the protest occurs, terminate the negative reinforcer.

7. Repeat for as long as the person is motivated to escape the negative reinforcer.

• If target behavior occurs:

l° Extinction (no escape from the negative reinforcer) for minutes, then begin prompt sequence for replacement behavior listed above.

l° If replacement, protesting behavior occurs during this time period, provide escape from the negative reinforcer.

l° Special instructions for delivery of small amount of reinforcer(s):

• Criterion for fading prompts:

• Criterion for increasing the amount of delay in the delivery of reinforcer:

Form 6.8 n Teaching Requesting Behavior: Simple Plan (continued )

286 Functional Behavioral Assessment, Diagnosis, and Treatment

ADDITIONAL RESOURCES Teaching Requesting Skills Arntzen, E., & Almås, I. K. (2002). Effects of mand-tact versus tact-only training on the acquisition of tacts. Journal of Applied Behavior Analysis, 35, 419–422. Bowman, L. G., Fisher, W. W., Thompson, R. H., & Piazza, C. C. (1997). On the relation of mands and the function of destructive behavior. Journal of Applied Behavior Analysis, 30, 251–265. Brown, K. A., Wacker, D. P., Derby, K. M., Peck, S. M., Richman, D. M., Sasso, G. M., & Harding, J. W. (2000). Evaluating the effects of functional communication training in the presence and absence of establishing operations. Journal of Applied Behavior Analysis, 33, 53–71. DeLeon, I. G., Fisher, W. W., Herman, K. M., & Crosland, K. C. (2000). Assessment of a response bias for aggression over functionally equivalent appropriate behavior. Journal of Applied Behavior Analysis, 33, 73–77. Derby, K. M., Wacker, D. P., Berg, W., DeRaad, A., Ulrich, S., Asmus, J., & Stoner, E. A. (1997). The long-term effects of functional communication training in home settings. Journal of Applied Behavior Analysis, 30, 507–531. Drasgow, E., Halle, J. W., & Ostrosky, M. M. (1998). Effects of differential reinforcement on the generalization of a replacement mand in three children with severe language delays. Journal of Applied Behavior Analysis, 31, 357–374. Henry, L. M., & Horne, P. J. (2000). Partial remediation of speaker and listener behaviors in people with severe dementia. Journal of Applied Behavior Analysis, 33, 631–634. Kahng, S., Hendrickson, D. J., & Vu, C. P. (2000). Comparison of single and multiple functional communication training responses for the treatment of problem behavior. Journal of Applied Behavior Analysis, 33, 321–324. Lalli, J. S., Mauro, B. C., & Mace, F. C. (2000). Preference for unreliable reinforcement in children with mental retardation: The role of conditioned reinforcement. Journal of Applied Behavior Analysis, 33, 533–544. Northup, J., Wacker, D., Sasso, G., Steege, M., Cigrand, K., Cook, J., DeRaad, A. (1991). A brief functional analysis of aggressive and alternative behavior in an outclinic setting. Journal of Applied Behavior Analysis, 24, 509–522. Partington, J. W., Sundberg, M. L., Newhouse, L., & Spengler, S. M. (1994). Overcoming an autistic child’s failure to acquire a tact repertoire. Journal of Applied Behavior Analysis, 27, 733–734. Peck, S. M., Wacker, D. P., Berg, W. K., Cooper, L. J., Brown, K. A., Richman, D., & Millard, T. (1996). Choice-making treatment of young children’s severe behavior problems. Journal of Applied Behavior Analysis, 29, 263–290. Richman, D. M., Wacker, D. P., & Winborn, L. (2001). Response efficiency during functional communication training: Effects of effort on response allocation. Journal of Applied Behavior Analysis, 34, 73–76. Sprague, J. R., & Horner, R. H. (1992). Covariation within functional response classes: Implications for treatment of severe problem behavior. Journal of Applied Behavior Analysis, 25, 735–745. Vollmer, T. R., Borrero, J. C., Lalli, J. S., & Daniel, D. (1999). Evaluating self-control and impulsivity in children with severe behavior disorders. Journal of Applied Behavior Analysis, 32, 451–466. Wallace, M. D., Iwata, B. A., & Hanley, G. P. (2006). Establishment of mands following tact training as a function of reinforcer strength. Journal of Applied Behavior Analysis, 39, 17–24.

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Winborn, L., Wacker, D. P., Richman, D. M., Asmus, J., & Geier, D. (2002). Assessment of mand selection for functional communication training packages. Journal of Applied Behavior Analysis, 35, 295–298. Yamamoto, J., & Mochizuki, A. (1988). Acquisition and functional analysis of manding with autistic students. Journal of Applied Behavior Analysis, 21, 57–64.

DIFFERENTIAL REINFORCEMENT OF ALTERNATIVE BEHAVIOR Goh, H., Iwata, B. A., & DeLeon, I. G. (2000). Competition between noncontingent and contingent reinforcement schedules during response acquisition. Journal of Applied Behavior Analysis, 33, 195–205. Lee, R., McComas, J. J., & Jawor, J. (2002). The effects of differential and lag reinforcement schedules on varied verbal responding by individuals with autism. Journal of Applied Behavior Analysis, 35, 391–402. McCord, B. E., Thomson, R. J., & Iwata, B. A. (2001). Functional analysis and treatment of self-injury associated with transitions. Journal of Applied Behavior Analysis, 34, 195–210. Piazza, C. C., Moes, D. R., & Fisher, W. W. (1996). Differential reinforcement of alternative behavior and demand fading in the treatment of escape-maintained destructive behavior. Journal of Applied Behavior Analysis, 29, 569–572. Ringdahl, J. E., Kitsukawa, K., Andelman, M. S., Call, N., Winborn, L., Barretto, A., & Reed, G. K. (2002). Differential reinforcement with and without instructional fading. Journal of Applied Behavior Analysis, 35, 291–294. Vollmer, T. R., Roane, H. S., Ringdahl, J. E., & Marcus, B. A. (1999). Evaluating treatment challenges with differential reinforcement of alternative behavior. Journal of Applied Behavior Analysis, 32, 9–23.

SME FUNCTIONS: ALTERNATE DIRECT ESCAPE FORM Brief Description In this replacement behavior option, the negative reinforcer is removed by the client engaging in a chain of behaviors that directly terminates or avoids the aversive item or event, independent of anyone else’s intervention.

To implement a DE program, you must determine what chain of behaviors can directly remove the aversive items or event. If the person can fluently perform the requisite chain of behaviors, a simple rearrangement of contingencies is all that is usually required. Performance of the chain of behaviors is allowed to remove the negative reinforcer. Concurrently, extinction of the target behavior (i.e., socially mediated) is programmed.

If the person does not currently possess the DE behavior, his or her behavior must be shaped to produce an effective response (see inept repertoire diagnosis in Chapter 4). In some cases, the entire chain of behaviors may have to be taught. In other cases, a few components of the chain may be lacking.

If the client can perform the chain of behaviors, but not fluently (i.e., with acceptable speed and accuracy), fluency training is required. Once the client has acquired fluent performance of the chain of behaviors, differential negative reinforcement as delineated in this program is implemented.

The advantage of this replacement behavior option is that it allows the client to independently escape or avoid aversive items or events without reliance on other people or having to use communication or social skills. The DE option develops a specific chain of behaviors that will continue to be functional for the client over time. Once these behaviors are acquired, they can be utilized in other situations through the process of shaping and generalization.

288 Functional Behavioral Assessment, Diagnosis, and Treatment

Terms Trigger analysis: Setting up all the conditions hypothesized to occasion the target behavior,

and documenting the occurrence (or lack thereof) of the target behavior and DE replacement behavior.

Apparatus Data sheets—See Form 6.9 “Simple Frequency Data With Formulas”

Baseline Measurement There are two different types of information you need to obtain. First, you need to determine how often the target behavior is occurring under relevant conditions. Additionally, you need the frequency of occurrence of the proposed alternate form of DE behavior under relevant conditions.

The frequency measure is simply a count of each time the person engages in the target behavior and a count of each time the person performs the alternate form DE behavior under the same conditions. This type of data is best collected via a trigger analysis. When considering this option, baseline rates for the direct access behavior are typically at or near zero.

Trigger Analysis (see Form 6.10) 1. Contrive or capture a situation in which escape or avoidance of the item or event

is highly likely. To accomplish this, set up motivational conditions, usually through temporary exposure to the negatively reinforcing items or events.

2. Observe the person’s behavior relative to the chain of alternate form DE behaviors. 3. Record the time the person takes to initiate the response and terminate the negative

reinforcer. 4. Record which steps were completed and any prompts required to facilitate the

performance of the steps. 5. Record if the negative reinforcer was terminated. 6. Repeat steps 1 through 5 at least two more times. 7. Graph or display the data across all baseline sessions.

If the baseline trigger analysis data indicates that the person does not appear to have the designated alternate form of DE behaviors in his or her repertoire, you will first need to teach the specific chain of behaviors to fluent performance.

If the baseline data indicates that the person is not performing the DE behavior, start by teaching the behavior using discrete trials. If the baseline data indicates that the person is able to perform the behavior, then skip to incidental teaching.

Discrete Trials

1. Present the aversive item or event to the person. 2. Prompt the person to perform the first step in the alternate DE behavior. 3. Provide reinforcement contingent on completing the behavior or chain of behaviors. 4. If the person does not complete the chain of behaviors, provide an additional prompt

to help complete the next step. 5. Provide reinforcement, preferably in the form of escape or avoidance of the aversive

item or event you want the person to directly escape with this behavior. 6. If the person engages in the target behavior, extinction in the form of blocking escape

or avoidance should occur until the target behavior has been absent for some short period of time. Then resume prompts to engage in the identified alternate form of the DE behavior.

6 Functional Behavioral Treatment Protocols for SME 4.0: Problem Behaviors 289

7. Record data. 8. On each successive trial, shape more independent responding by reducing the level

of prompt provided. 9. Once the person is performing the task without the need for additional prompts,

change to incidental teaching method.

Incidental Teaching

1. Observe for conditions under which the person would usually engage in the target behavior.

2. If the person directly escapes or avoids an item or event without engaging in a target behavior, allow him or her to do so.

3. If the person does not escape or avoid the item or event, provide a prompt to engage in the DE behavior.

4. If the person does not complete the task, provide an additional prompt to help him or her complete the next step.

5. On each successive trial, shape more independent responding by reducing the level of prompt provided.

6. If the person engages in the target behavior, extinction in the form of blocking escape or avoidance should occur until the target behavior has been absent for some short period of time. Then resume prompts to engage in the identified alternate form of the DE behavior.

7. Record data.

If utilizing this behavior option for DE behaviors: Utilize the same baseline and treatment procedures as above, except that chain interruption would occur instead of extinction when the target behavior is displayed.

Ensure Escape or Avoidance of the Negative Reinforcer!

It is critical that, during the time that the person is learning to perform the alternate form DE chain of behaviors, the negative reinforcer be terminated every time the alternate form DE behavior occurs. If the rate of the alternate form DE replacement behaviors becomes too high with ad lib escape, you may consider setting up a DNRO or Premack contingency as an additional replacement behavior option to gradually reduce the rate of escape.

How It Works When the person is motivated to escape a particular item or event and can do so directly, it will become functional very quickly. The alternate DE form behavior will probably remove the negative reinforcer at a higher rate and more reliably than the target behavior that required other people to be involved. There is no reliance on ancillary skills such as initiating a social interaction or making a request.

Hypothetical Example

I Want to Change, Please

John is a person diagnosed with schizophrenia living in a locked psychiatric facility who was referred for services due to “stripping off his clothes.” Mr. Clay was assigned the case and began the assessment process by reviewing the data the facility was keeping. He then proceeded to interview the staff of the facility to understand the definitions of the targeted behaviors and gain information about the conditions under which the behavior occurs.

The data Mr. Clay obtained from the records for the previous week are presented in Example Form 6.9A.

290 Functional Behavioral Assessment, Diagnosis, and Treatment

Example Form 6.9A n Simple Frequency Data

• Client: John Chart Started: _______________

Day/Month/Year

• Behavior: stripping

• Total Observation Time: min (____,___-minute session/day) Session Length: min

• Number of Days: 7

• Place an X on the appropriate day box each time the behavior occurs

1 2 3 4 5 6 7 Totals

Target behavior xxxx xxxxx xxx xxxxx xxxx xxxxx xxxxxx

Daily rate 4 5 3 5 4 5 6 32

Mr. Clay asked the staff to describe what the behavior looked like the last time it happened and if there was much variation across occurrences. The staff reported that it was typically the same each time. John would walk up to the nurses station and remain there briefly. He would then walk around the facility and begin to slowly unbutton his clothing. He would often be in a moderate state of undress. He would then return to the nurses’ station and tell the staff that “animals don’t wear clothes.” The staff indicated that, if they talked with him, he would briefly stop disrobing. However, after a short period of time, he would resume saying “animals don’t wear clothes” and proceed to remove his clothing one piece at a time. The staff told Mr. Clay they believed his behavior was the result of some traumatic experience he had while wearing a wool sweater. Mr. Clay was interested in their rationale for such an inference and asked why they hypothesized this. One staff member said, “He seems to make more delusional statements and strip more often when he is wearing a wool sweater.”

Mr. Clay suspected that the odd repetitive statements and the wool sweater might have something to do with the function of the behavior. He asked the staff a series of questions:

Mr. Clay : Does he strip if he is not wearing a wool sweater? Staff : Oh yes, it also happens when most of his clothing is in the laundry and he has

only the clothes he doesn’t like left to choose from. Mr. Clay : Do you ever find John in his room with no clothes on and no one else around? Staff : No, he usually only strips when we are around. Mr. Clay : Has John ever failed to dress after showering? Staff : No, he generally doesn’t like the other clients to see him naked. Mr. Clay : So, given a choice of his preferred clothing items and being naked, which

would he choose? Staff : Oh, he would definitely be in sweat pants and a t-shirt.

Because John was not likely to strip if no one else was there to see it, Mr. Clay was fairly certain that the behavior did not function to access sensory stimulation secondary to being naked. Further questioning revealed that the behavior happened only when John had on clothing he did not pick out himself and that the “stripping” behaviors stopped as soon as he changed into more preferred clothing. With this information, Mr. Clay was reasonably sure that the behavior served an escape function and that the diagnosis would be SME 4.4: Aversive Physical Stimuli or Event (see Table 6.7).

Mr. Clay wondered why John would make delusional statements and strip as a way to get a change of clothes. Why would he not just go to his room and change? He asked the staff if

6 Functional Behavioral Treatment Protocols for SME 4.0: Problem Behaviors 291

TABLE 6.7 n DIAGNOSTIC TABLE FOR STRIPPING BEHAVIOR

Diagnosis SME 4.4: Aversive Physical Stimuli/Event

Target behavior(s): Stripping off clothing

Function: Escape uncomfortable clothing items

Target behavior likely under following contexts:

Wearing less preferred clothing, most notably wool sweaters, and not allowed direct access to alternative clothing items under this condition

Target behavior unlikely under following contexts:

Free access (choice) to preferred clothing

Rule out: SMA 2.1: Adult Attention DA 1.1: Immediate Sensory Stimuli

SMA, socially mediated access; SME, socially mediated escape. DA, direct access.

they had ever seen John change into preferred clothing independent of staff. The staff replied “No, if we let him change once, he would keep changing all day, and if we let him choose his own clothes, he will wear the same dirty clothes day after day. Clothes changing is just a part of his delusional system around being an animal. His delusions are so bad that we had to put all his clothes in a locked closet to stop him from changing all the time.”

Now the delusional statements made sense to Mr. Clay, as did the stripping behavior. The only way to get out of wearing uncomfortable clothing was through staff mediation. Staff would provide the change of clothes only if John stripped off his other clothing. The delusional statements were an attempt to tell the staff what he wanted.

Mr. Clay could have simply instructed the staff to follow the current procedure of blocking access to clothing and added an extinction component by instructing staff to have John put on the same clothes each time he stripped. However, John would probably have developed a new set of behaviors that made the clothing unwearable. He decided that staff will simply teach John to change into preferred clothing when he was uncomfortable. Mr. Clay found out from the staff that John’s favorite outfit was light-weight sweat pants and a loose-fitting cotton t-shirt. The staff objected to this plan saying that they had tried that before, and he would just wear the same clothes every day. When they took away the clothes he wore every day, he would change clothing constantly all day long.

In order to test the staff members’ hypothesis, Mr. Clay set up a simple analysis to find out what John might do given free access to choose and change his own clothes. Mr. Clay asked the staff to dress John in clothing that they reported he was very likely to strip off. Mr. Clay asked that they also provide him with the key to John’s room and clothing closet (recall that access to his clothes had been prevented by placing them in a locked closet, which he could access only with staff assistance). Mr. Clay then waited at the nurses’ station for John to stop by and make the statement that “animals don’t wear clothes.” When this occurred, Mr. Clay provided a simple prompt of “Would you like to change into some different clothes?” The instructions for this trigger analysis and the data are presented on Example Form 6.10.

Mr. Clay also observed that John wore the clothing items for the rest of the day. John did not engage in multiple changes of clothing, indicating that it was indeed most likely the aversive stimulation from particular clothes that was establishing the value of stripping behavior.

Mr. Clay now could develop a simple contingency plan that he knew would eliminate the “stripping.” If John had not been able to complete the task, Mr. Clay would have completed a Task Analysis and developed a plan to teach him the skill using a combination of Discrete Trial Training, Incidental Teaching, Chaining, and behavioral fluency.

Mr. Clay developed a simple DE plan (see Example Form 6.11). If John “strips,” he will be required to dress in the clothes he had just removed until the target behaviors had been absent for 10 minutes. If John goes to his room and changes into preferred clothing, he is free to wear them. John is to have free access to preferred clothing at all times. Staff will

292 Functional Behavioral Assessment, Diagnosis, and Treatment

Example Form 6.9B n Simple Frequency Data

• Client: John Chart Started: _____________

Day/Month/Year

• Target Behavior: Stripping

• DE Behavior: Changing clothes in discrete area

• Total Observation Time: min (__,___-minute session/day) Session Length: min

• Number of Days: 7

• Place an X on the appropriate day box each time the behavior occurs

A. Total minutes observed: ___

B. Total occurrences observed: 3

C. Range (low) 0 to (high) 2, Avg = 0.43

A. Total minutes observed: ___

B. Total occurrences observed: 16

C. Range (low) 2 to (high) 3, Avg = 2

Target 1 2 3 4 5 6 7 Totals

Stripping xx x

Daily rate 2 1 0 0 0 0 0 3

Replacement 8 9 10 11 12 13 14 Totals

Changing clothes in discrete area

xxx xx xxx xx xx xx xx

Daily rate 3 2 3 2 2 2 2 16

6 Functional Behavioral Treatment Protocols for SME 4.0: Problem Behaviors 293

Trial Date Time Start Time End Step % Task Comp.

1 2 3 4 5 6 7

1 1/1 11:30 12:00 P I I I I I I 86%

2 1/1 4:30 4:50 P I I I I I 86%

3 1/2 4:30 4:45 P I I I I I I 86%

4 1/3 11:30 11:40 P I I I I I I 86%

5 1/4 11:30 11:40 P I I I I I I 86%

6 1/5 11:30 11:40 P I I I I I I 86%

Example Form 6.10 n Trigger Analysis Instruction and Data

• Client name: John

• Antecedent set up:

• Motivation for the reinforcing item will be assured by: Dressing him in clothing items that have previously occasioned stripping behavior

• Availability of the reinforcing item will be indicated by: A verbal prompt and alternative clothing items available in his room

• Type and sequence of prompts to be used: Verbal then gestural

• Preferred response: Chooses and puts on preferred clothing items. No more than one clothing change in an 8-hour period of time

• Conditions regarding access to the reinforcing item:

l° How much: 1 clothing change l° How long: N/A

• I = Independent P = prompted N = did not complete

• Independent completion rate: Whole task: 0/6

• Prompted completion rate: Whole task: 6/6

• Time to complete task:

l° Longest 30 min l° Shortest 10 min l° Average 15.83 min

Step Description

1 Initiation

2 Go to room

3 Open closet

4 Pick out shirt

5 Pick out pants

6 Disrobe in private area

7 Put on new clothing

294 Functional Behavioral Assessment, Diagnosis, and Treatment

continue take data on “stripping” and also record the number of times John changes his clothing per shift.

The plan was implemented and produced the data presented on Example Form 6.9B. As can be seen in the data, the program was very successful in disabling the function

of the stripping behavior and enabling the function of choosing and discretely changing into more comfortable clothing. It is also interesting to note that clothes changing did not occur at an excessive rate. One further note of interest is that there were no more delusional statements regarding animals not wearing clothes.

The next phase in the training process would be to teach John to independently identify the general fabrics and styles of clothing he prefers so that he can pick them out when he is shopping for new clothing.

What If?

What if the person refuses or is unable to complete the DE behavior?

This would require teaching the person the skill first. If the person was unable to acquire the skill, then some environmental set-up would be needed to allow him or her a way to escape the negative reinforcer directly. If that were still not possible, an alternative might be to use noncontingent negative reinforcement.

What if the DE behavior results in the person escaping the negative reinforcer at too high a rate?

If this occurs, the simplest solution would be to implement a DNRO or Premack contingency option such that the person could still directly escape the negative reinforcer,

Example Form 6.11 n Direct Escape: Plan

• Person served: John

• Target behavior: Stripping

• Behavioral diagnostic category: SME 4.4: Aversive Physical Stimuli/Event

• Direct access behavior: Changing into preferred clothing

• Designated time period(s): Any

• Rate of target behavior Baseline: 4.6 per day Target: 0

• Rate of direct access behavior Baseline: 0 Target: 2 per day

• Initial form or task analysis of direct access behavior: Choose preferred clothing items and dress himself in a discrete location (bedroom/bathroom), changing clothes no more than once per 8-hour time period.

• Reinforcing item/event to be directly escaped: Nonpreferred clothing.

• When and how will it be made available: Initially preferred clothing items will simply be available in his now unlocked closet.

• How to respond to the target behavior: Have John get redressed in the clothing he just stripped off. After 10 minutes of no stripping behavior, prompt him to go to his room to choose and change clothes to more preferred clothing items.

• Types of prompts to be used:

□ Visual ⊠ Vocal ⊠ Gestural □ Written □ Touch □ Graduated Guidance

• When to use prompts: Vocal prompt to change into preferred clothing items should be made when John stops by the nurses’ station and makes the statement that “animals do not wear clothes.”

6 Functional Behavioral Treatment Protocols for SME 4.0: Problem Behaviors 295

Form 6.9 n Simple Frequency Data With Formulas

• Client: _________________ Chart Started: _____________

Day/Month/Year

• Behavior:

• Number of Days: _____

• Place an X on the appropriate day box each time the behavior occurs

A. Total minutes observed: ___

B. Total occurrences observed: ___

C. Range (low) ____ to (high) ___, Avg = ___

A. Total minutes observed: ____

B. Total occurrences observed: ____

C. Range (low) ___ to (high) ___, Avg = ____

1 2 3 4 5 6 7 Totals

Target behavior

Daily rate

8 9 10 11 12 13 14 Totals

Direct escape behavior

Daily rate

but the complexity or duration of the behavior required prior to escape could be increased and thereby reduce the frequency of escape.

What if the person can do the DE behavior but is too slow?

If the person is simply taking too long to complete the task, you should consider fluency training or differential reinforcement of higher rates (DRH) of behavior. In fluency training, the focus is on breaking down each component step of the overall task to be completed and increasing the speed of movement of each component rather than focusing on accurate performance of the entire task. Accuracy of the entire task develops as each component can be performed fluently. DRH focuses on differentially reinforcing the person performing the behavior faster. So the faster they do the behavior, the greater the pay off. Both methods are effective at speeding up slow performances.

Forms: DE

6.9 Simple Frequency Data With Formulas 6.10 DE Trigger Analysis Trial Data Sheet 6.11 DE: Simple Plan

296 Functional Behavioral Assessment, Diagnosis, and Treatment

Step 1 Step 2 Step 3 Step 4 Step 5 Step 6 Step 7

Trials Date Time Start

Time End

Step % Task Comp.

1 2 3 4 5 6 7 1 2 3 4 5 6 7 8 9 10

Form 6.10 n DE Trigger Analysis Trial Data Sheet

• Client name:

• Antecedent set up:

• Motivation for the escape from the negatively reinforcing item will be ensured by:

• Availability of escape from the negative reinforcer will be indicated by:

• Type and sequence of prompts to be used:

• Preferred response:

• Conditions regarding escape from the negatively reinforcing item:

l° How much:

l° How long:

• I = Independent P = prompted N = did not complete

• Independent completion rate: Whole task: __________

• Prompted completion rate: Whole task: __________

• Time to complete task:

l° Longest:

l° Shortest:

l° Average:

6 Functional Behavioral Treatment Protocols for SME 4.0: Problem Behaviors 297

ADDITIONAL RESOURCES Bosch, S., & Fuqua, R. W. (2001). Behavioral cusps: A model for selecting target behaviors. Journal of Applied Behavior Analysis, 34, 123–125. Dattilo, J., & Camarata, S. (1991). Facilitating conversation through self-initiated augmentative communication treatment. Journal of Applied Behavior Analysis, 24, 369–378. Mithaug, D. K., & Mithaug, D. E. (2003). Effects of teacher-directed versus student-directed instruction on self-management of young children with disabilities. Journal of Applied Behavior Analysis, 36, 133–136. Thompson, R. H., & Iwata, B. A. (2000). Response acquisition under direct and indirect contingencies of reinforcement. Journal of Applied Behavior Analysis, 33, 1–11. Vaughn, B. J., & Horner, R. H. (1997). Identifying instructional tasks that occasion problem behaviors and assessing the effects of student versus teacher choice among these tasks. Journal of Applied Behavior Analysis, 30, 299–312.

SME FUNCTIONS: NONCONTINGENT ESCAPE (NCE) OPTION Brief Description In noncontingent escape (NCE), the specific maintaining negative reinforcer is removed following a given period of time. The negative reinforcer is removed even if the target behavior has or is occurring. One could view an NCE as a reinforcement system that reduces the rate of behavior by removing the motivation to engage in the target behavior or that operates by disrupting the contingent relationship between the behavior and the removal of the negative reinforcer.

Form 6.11 n DE: Simple Plan

• Person served:

• Target behavior:

• Behavioral diagnostic category:

• Designated time period(s):

• Rate of target behavior Baseline: Target:

• Rate of DE behavior Baseline: Target:

• Initial form or task analysis of DE behavior:

• Negatively reinforcing item/event to be directly escaped:

• When and how escape will be made possible:

• How to respond to the target behavior:

• Types of prompts to be used:

□ Visual □ Vocal □ Written □ Touch □ Graduated Guidance

• When to use prompts:

298 Functional Behavioral Assessment, Diagnosis, and Treatment

To implement this option, you would determine how frequently to remove the negative reinforcer. You would then remove the negatively reinforcing item based on that schedule.

The advantage of using an NCE procedure is that it is easy to implement and generally will rapidly reduce the occurrence of target behaviors. NCE procedures generally do not teach or strengthen any new replacement behaviors. They alter the rate of the target behavior initially by removing the motivation underlying the targeted behavior. Generally, NCE will be used in conjunction with other replacement function options that are designed to strengthen specific replacement functions, DNRA, or tolerance, DNRO. NCE may not be useful in situations where frequent escape from the maintaining reinforcer is impractical, not feasible, or dangerous.

Terms Schedule of reinforcement: The interval schedule of noncontingent removal of the

maintaining negative reinforcer. Interbehavior interval: The length of time that passes between the end of one targeted

behavior and the beginning of the next occurrence of the targeted behavior. Thinning schedule of removal of the maintaining negative reinforcer: The process of gradually

increasing the amount of elapsed time between removal of the negative reinforcer.

Apparatus Timing device—This can be a kitchen timer, alarm clock, computer with alarm feature, tape

recorder with beeps at designated intervals, or a calendar, depending on the length of the schedule of NCR. Its purpose is to prompt the staff person, teacher, or parent to provide the reinforcer.

Data sheets—See Form 6.12 “Partial Interval Data, 30-Minute Intervals”

Baseline Measurement Baseline measurement consists of determining the interbehavior interval for the target behavior. To accomplish this, a partial interval method is used for recording the occurrence of the target behavior. Partial interval methods of recording are useful when dealing with behaviors that may be difficult to keep track of or when staff persons have many other duties besides collecting data.

Steps to Collect Baseline Data Using Partial Interval Recording

1. Identify the target behavior to be observed. 2. Operationally define or pinpoint the behavior being observed. 3. Determine the observation period, possibly reviewing scatter plot or A-B-C data to

identify periods of time when behavior is highly likely. 4. Determine the length of the observation period, and divide the observation period

into equal interval blocks (keeping these the same across baseline sessions). 5. Construct the data sheet. 6. During observation, enter date and time of day on data sheet and set timing device

for interval length. 7. At the end of each interval, if the target behavior occurred at all, place an X in the

corresponding interval on the data sheet. 8. Repeat step 7 until the observation period ends. 9. Sum the total number of intervals in which a target behavior occurred, and enter that

number on the data sheet. 10. Continue observing client and target behavior for at least four more baseline sessions.

6 Functional Behavioral Treatment Protocols for SME 4.0: Problem Behaviors 299

For example, the staff person records partial interval data on the rate of occurrence of the targeted behavior on the data sheet found in Table 6.8. Observations are made five times per day, for 10 minutes. If the behavior occurs within a given 2-minute interval, an X is placed on that respective interval. Therefore, the data sheet in Table 6.8 for 1 day of observation reveals a grid, involving five intervals per observation across five observation sessions.

As you can see, in the first observation period (column marked Day 1), the client engaged in the target behavior only during the second and fourth interval during the entire 10-minute observation. During the next observation period, the client engaged in the target behavior in intervals 1, 2, 3, and 5. The totals at the bottom of each column are out of a possible of 5 intervals in which the behavior can be recorded. Summing across the row labeled “total” yields 16 intervals in which the target behavior was recorded as having occurred (against a total of 25 intervals for 5 days of observation). With this ratio 16/25, one can compute the percentage of occurrence, in this case 64% of intervals.

The interbehavior interval can also be calculated by dividing the number of minutes of observation for the week (50) by the number of intervals on which the target behavior occurred (16), which yields an average interbehavior interval of 3.125 minutes. In other words, the target behavior occurs about every 3 minutes. In this example, it is important to note that the rate of target behavior is relatively stable across the five observation periods. If it were more varied, one should examine what factors were different at each observation to account for the variability in rate of occurrence.

Interval # Day 1 10:30

Day 2 12:10

Day 3 1:10

Day 4 2:15

Day 5 2:45

1 x x x x

2 x x x x

3 x

4 x x

5 x x x

Total 2 4 2 4 2

Grand total = 16 intervals with target behavior over a possible 25 intervals Interbehavior interval = 50 min/16 intervals with behavior = 3.125 minutes

TABLE 6.8 n BASELINE INTERBEHAVIOR INTERVAL

Condition: Baseline

Recording Method: Partial interval

Interval Length: 2 minutes

Client: Arthur Chart Started: 2-1-08

Day/Month/Year

Behavior: XXX

Total Observation Time: 50 min (1, 10-minute session/day) Session Length: 10 min

Number of Days: 5

□ Behavior did NOT occur ⊠ Behavior DID occur

Day of the month/Start time

300 Functional Behavioral Assessment, Diagnosis, and Treatment

NCE Procedures 1. From baseline data, calculate the interbehavior interval. 2. Determine your schedule of escape from the maintaining negative reinforcer. (The

initial schedule should be set so that reinforcement occurs at or more frequently than the shortest interbehavior interval, e.g., initial interval set at 80% of the average interbehavior interval.)

3. Identify conditions under which the client will be exposed to the negative reinforcer. 4. During the identified time periods, set the timing device to the initial escape

schedule. 5. When the timer goes off, remove the negative reinforcer for a prespecified period

of time. The duration of escape will depend on the specific negative reinforcer. If possible, do not let the target behavior produce escape.

6. Reset the timer. 7. Record data on data sheet.

Thinning the Schedule of Delivery of Maintaining Reinforcer

The schedule is thinned when the target behavior goal is achieved. When the goal is achieved, increase the length of time between the removal of the negative reinforcer, and set a new target behavior goal. The steps for thinning the schedule follow.

1. When the target behavior goal is achieved with the program, increase the length of the interval between NCE by 5% to 10%. For example, if the length of time between NCE was 5 minutes and the target behavior goal was met, the new schedule for escape might be set at 5 minutes, 30 seconds.

2. With each week of success in achieving the target behavior goal, the schedule of delivery is increased progressively by 10%.

3. If the target behavior occurs at a rate higher than the target behavior goal consistently over a given week, consider returning to the previous schedule of reinforcement.

4. If you have made several attempts at thinning the schedule but are unable to get past a particular rate of escape, it may be best to keep the schedule at that level while incorporating another functional treatment option.

How It Works 1. By eliminating the client’s motivation for escape from a particular negatively

reinforcing item or event: When there is no motivation to escape the item or event, there is no reason for the person to engage any behaviors that previously removed that negative reinforcer.

2. By disrupting the learned contingency between the client’s target behavior and the removal of the negatively reinforcing event: That is, the negative reinforcing event is removed on some time schedule regardless of occurrence of the target behavior, so the person may learn that the unwanted behavior is no longer correlated with the removal of the negative reinforcer (extinction by unpairing).

Hypothetical Example

Enough Is Enough

Kalena, a third-grade student in a special education classroom, hits herself in the head and face when she is pressed to continue a task (SME 4.2: Lengthy Task/

6 Functional Behavioral Treatment Protocols for SME 4.0: Problem Behaviors 301

Chore/Assignment). In the past, when she engaged in this behavior, she was moved to another activity, whereupon such self-injury ceased. Dr. Stengel was asked to assess this child and find a way to reduce the self-injury. After obtaining a general description of the behavior, Dr. Stengel observed Kalena in her classroom over the course of 5 days. Using partial interval data collection, Dr. Stengel obtained the data presented in Example Form 6.13A.

In graphing the data recorded on Form 6.13A, it appeared that there was an increasing trend in the occurrence of the target behavior (2, 3, 4, and 5 intervals on consecutive days). (See Figure 6.4.)

Dr. Stengel could have calculated the interbehavior interval on the cumulated data, and it would have looked like this:

100 minutes ÷ 18 intervals with aggression = 5.56 minutes

In order to increase the likelihood of getting a positive effect quickly, Dr. Stengel calculated the interbehavior interval based on the session with the most occurrences, thus ensuring that the rate of NCE was higher than the rate of escape she was currently receiving for self- injurious behaviors (SIB).

Example Form 6.13A n Partial Interval Data

Day of the month

Interval # 7/5 7/6 7/7 7/8 7/9

1 x x

2 x x

3 x x

4 x x

5 x

6 x x x

7

8 x x x

9 x x x

10

2 3 4 4 5

• Condition: Baseline Recording Method: Partial interval

• Client: Kalena Chart Started: 7/5

Day/Month/Year

• Behavior: Self-injury

• Interval Length: 2 minutes Total Observation Time: 100 min

Session Length: 20 min

□ Behavior did NOT occur ⊠ Behavior DID occur

302 Functional Behavioral Assessment, Diagnosis, and Treatment

FIGURE 6.4 n Baseline self-injury data.

60 Kalena Self Injury

50

Baseline

40

% o

f in

te rv

al s

in w

hi ch

s el

f in

ju ry

o cc

ur re

d

30

Days

20

10

0 7/6 7/7 7/8 7/97/5

Dr. Stengel counted the total number of minutes of the observation (20) and divided it by the total number of intervals in which SIB occurred (5). This gave her an average interbehavior interval of 4 minutes.

20 minutes ÷ 5 intervals with self-injury = 4 minutes

Dr. Stengel now knew the rate of the target behavior but did not yet know the function. She determined that the behavior was probably socially mediated as it never occurred when Kalena was alone and had been observed only when adults and students were in close proximity. From her observations, Dr. Stengel had noticed that the SIB seemed to occur only when Kalena was working on math assignments and stopped when the math assignment was removed. This information made it less likely that the SIB functioned to access attention. If SIB was maintained by attention, it should happen at times other than when math work was given to Kalena. The target behavior stopped after math was removed, indicating the behavior likely functioned to produce escape. Kalena would, however, start to work on math for a period of time prior to engaging in SIB. Dr. Stengel hypothesized that SIB probably served to terminate relatively lengthy math tasks (SME 4.2: Relatively Lengthy Tasks/Chores/Assignments see Table 6.9).

To test this hypothesis, Dr. Stengel set up the following conditions. For 8 days during math class, she would present math work to Kalena. On 4 days she would present assignments that lasted an entire 15 minutes (full = F), that is, the student keeps working until 15 minutes is up. On the other 4 days, she would present short assignments that would last only 3 to 5 minutes (short = S). Once the assignment was finished, the session would end and Kalena could go to an entertaining activity for 30 seconds. After the 30-second break, Kalena was asked to do another math assignment of 3 to 5 minutes. This cycle was repeated three times so that the total time on task was equivalent to the 15-minute full condition. The only difference in instructions for the short condition was that Dr. Stengel provided the prompt, “Let’s do just this one task before we take a break.” Each time SIB occurred in either short or full sessions, Dr. Stengel gave Kalena a 1- to 2-minute break from the assignment. The assessment produced the data listed in Table 6.10.

Dr. Stengel now was fairly certain that her hypothesis was correct and that she could probably reduce the rate of SIB using a simple NCE contingency.

6 Functional Behavioral Treatment Protocols for SME 4.0: Problem Behaviors 303

TABLE 6.10 n SIB HYPOTHESIS TEST

Session 1 2 3 4 5 6 7 8

Full or short F F S F S S F S

Number of behaviors 8 7 1 12 4 1 6 0

On-task rate % 40 30 70 25 60 75 45 65

TABLE 6.9 n DIAGNOSTIC TABLE FOR SELF-INJURY

Diagnosis 4.2 SME: Relatively Lengthy Tasks/Chores/Assignments

Target behavior(s): Self-injury

Function: Escape a math task after more than 5 minutes of continuous math

Target behavior likely under following contexts:

Math for time periods exceeding 5 minutes

Target behavior unlikely under following contexts:

Free time or working on tasks other than math

Rule out: SMA 2.1: Adult Attention SMA 2.2: Peer Attention SME 4.1: Unpleasant Social Situations SME 4.3: Relatively Difficult Tasks/Chores/Assignments SME 4.4: Aversive Physical Stimuli/Event

SMA, socially mediated access; SME, socially mediated escape.

Dr. Stengel decided to start with an NCE schedule that required the aide to remove the task from Kalena every 4 minutes. She provided the staff with a simple plan to deliver NCE (see Example Form 6.14).

She started the intervention on the 12th. The staff were very excited by the results of their intervention. The data are presented on Example Form 6.13B.

We can present the same data in graphical format to more easily see the trends (see Figure 6.5).

Based on the data that no aggression had occurred for 3 consecutive days, Dr. Stengel changed the schedule of escape to every 3.5 minutes.

3 minutes (current schedule) × 1.10 (10 percent increase) = 3.3 minutes

(Note: Because the time frames were relatively short, and Dr. Stengel knew that her timing device would make it difficult to track anything smaller than half a minute, she rounded up to 3.5 minutes.)

There was one event of self-injury on the first day of the new schedule but no further occurrences for 3 days after that. Dr. Stengel continued this process until the schedule had been thinned to every 10 minutes. After consultation with the teacher and teacher’s aide as to the feasibility, Dr. Stengel decided to keep the NCE schedule at this level while they taught Kalena some new behaviors that she could use to request a break. Kalena continued to have no events of self-injury. During the acquisition, a simple request for a break, in this

304 Functional Behavioral Assessment, Diagnosis, and Treatment

FIGURE 6.5 n Self-injury data.

60

50

40

% o

f in

te rv

al s

in w

hi ch

s el

f- in

ju ry

o cc

ur re

d

30

20

10

0

Days

7/5 7/237/227/217/207/197/187/177/167/157/147/137/127/117/107/97/87/77/6 7/24

Baseline

NCR

Interval # 7/12 7/13 7/14 7/15 7/16 7/17 7/18 7/19 7/20 7/21 7/22 7/23 7/24

1

2 x

3 x x

4

5 x

6

7

8

9

10

3 0 0 0 1 0 0 0 0 0 0 0 0

Example Form 6.13B n Partial Interval Data

• Condition: Treatment Recording Method: Partial interval

• Interval Length: 2 minutes

• Client: Kalena Chart Started: 7/12

Day/Month/Year

• Behavior: Self-injury

• Total Observation Time: 100 min Session Length: 20 min

□ Behavior did NOT occur ⊠ Behavior DID occur

6 Functional Behavioral Treatment Protocols for SME 4.0: Problem Behaviors 305

case signing “break,” it was noted that Kalena could make the request quite well during training but was not using it during seat work in class. Dr. Stengel surmised that the NCE that was keeping the self-injury from occurring did so by eliminating the motivation to do any behavior that functioned to produce adult attention. She therefore began thinning the schedule of NCE. Upon reducing the NCE, Kalena began to use the requesting behavior she had learned. Dr. Stengel continued to collect data and thin the schedule of NCE until reaching the targeted interbehavior interval of 15 minutes. Dr. Stengel then discontinued the NCE but continued to take data for 1 month to ensure that the replacement behavior would continue to be effective in escaping lengthy seat work tasks.

What If?

What if the behavior does not decrease (or gets worse) with NCE?

This may happen, although it is less likely with this program than with others. When the target behavior is no longer effective in escaping the negative reinforcer, it may occur more

Example Form 6.14

• Person served: Kalena

• Target behavior: Self-injury

• Target behavior goal: Self-injury in less than 1% of observed intervals

• Designated time period(s): Math time 25 minutes per day

• Baseline data across five times/sessions: 1. 2

2. 3

3. 4

4. 4

5. 5

• % of intervals in which target behavior occurred Baseline: 40% Target: <1%

• % of intervals in which negative reinforcement occurred Baseline: ______ Target: ______

• Interbehavior interval Baseline: 4 min Target: 15 min

• Initial schedule of noncontingent escape: l° X Fixed time schedule every 3 minutes/hours/days

OR l° _____ Variable time schedule on average every _____ minutes/hours/days

• Reinforcer(s) to be used: 1. Remove schoolwork for 30 seconds

2. ____________________________ 3. ____________________________ 4. ____________________________ 5. ____________________________

• Special instructions for removal of negative reinforcer(s): Remove all school work and allow Kalena to engage in any desk activity of her choosing during the 30 seconds. Following the 30 seconds, place the work in front of her and direct her to begin working.

• Criterion for increasing amount of time between removal of negative reinforcers: When self-injurious behavior occurs in <1% of intervals observed for 3 consecutive days, increase time between NCE escape by 10.

• Criterion for decreasing the amount of time between removal of negative reinforcers: If self-injurious behavior occurs in more than 5% of observed intervals for 3 consecutive days, decrease time between noncontingent escape by 1 minute.

306 Functional Behavioral Assessment, Diagnosis, and Treatment

frequently (called an extinction burst). If it occurs during NCE, it is possible the schedule of delivery is not dense enough. Try shortening the time between allowing escape. If there is still no effect, it is very likely that your functional assessment was incorrect and that there is a different reinforcer maintaining the target behavior. It would be best to return to taking A-B-C data and repeat the functional assessment.

Forms: NCE

6.12 Partial Interval Data, 30-Minute Intervals 6.13 Partial Interval Data, 2-Minute Intervals 6.14 NCE: Simple Plan 6.15 Formulas for Calculating Percentage of Intervals of Targeted Behavior and

Interbehavior Interval 6.16 Formulas for Determining Increases or Decreases in Frequency of NCE

Form 6.12 n Partial Interval Data, 30-Minute Intervals

Day of the month/Start time

• Condition: Baseline or Treatment Recording Method: Partial Interval

• Client: Chart Started:

Day/Month/Year

• Behavior:

• Interval Length: 30 minutes Total Observation Time: __ Session Length: __

□ Behavior did NOT occur ⊠ Behavior DID occur

Interval #

Interval Length

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

1 6:30 a.m.

2 7:00 a.m.

3 7:30 a.m.

4 8:00 a.m.

5 8:30 a.m.

6 9:00 a.m.

7 9:30 a.m.

8 10:00 a.m.

9 10:30 a.m.

10 11:00 a.m.

11 11:30 a.m.

12 12:00 p.m.

13 12:30 p.m.

14 1:00 p.m.

15 1:30 p.m.

(continued )

6 Functional Behavioral Treatment Protocols for SME 4.0: Problem Behaviors 307

Interval #

Interval Length

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

16 2:00 p.m.

17 2:30 p.m.

18 3:00 p.m.

19 3:30 p.m.

20 4:00 p.m.

21 4:30 p.m.

22 5:00 p.m.

23 5:30 p.m.

24 6:00 p.m.

25 6:30 p.m.

26 7:00 p.m.

27 7:30 p.m.

28 8:00 p.m.

29 8:30 p.m.

30 9:00 p.m.

31 9:30 p.m.

32 10:00 p.m.

Form 6.13 n Partial Interval Data, 2-Minute Intervals

Day of the month/Start time

• Condition: Baseline or Treatment Recording Method: Partial interval

• Client: Chart Started:

Day/Month/Year

• Behavior:

• Interval Length: 2 minutes Total Observation Time: __ Session Length: __

□ Behavior did NOT occur ⊠ Behavior DID occur

Interval # 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

1

2

3

(continued )

Form 6.12 n Partial Interval Data, 30-Minute Intervals (continued )

308 Functional Behavioral Assessment, Diagnosis, and Treatment

Interval # 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

32

Form 6.13 n Partial Interval Data, 2-Minute Intervals (continued )

6 Functional Behavioral Treatment Protocols for SME 4.0: Problem Behaviors 309

Form 6.14 n NCE: Simple Plan

• Person served:

• Target behavior:

• Behavioral diagnostic category:

• Target rate:

• Designated time period(s):

• Baseline data across five times/sessions:

1.

2.

3.

4.

5.

• % of intervals in which target behavior occurred Baseline: __________ Target: __________

• % of intervals in which negative reinforcement occurred Baseline: __________ Target: __________

• Interbehavior interval Baseline: __________ Target: __________

• Initial schedule of noncontingent escape:

• _____ Fixed time schedule every _____ minutes/hours/days

OR

• _____ Variable time schedule on average every _____ minutes/hours/days

• Reinforcer(s) to be used: 1. __________

2. __________

3. __________

4. __________

5. __________

• Special instructions for removal of negative reinforcer(s):

• Criterion for increasing amount of time between removal of negative reinforcers:

• Criterion for decreasing the amount of time between removal of negative reinforcers:

310 Functional Behavioral Assessment, Diagnosis, and Treatment

Form 6.15 n Formulas for Calculating Percentage of Intervals of Targeted Behavior and Interbehavior Interval

• % of occurrence: This formula will help you determine how often a behavior is occurring. Use this information to assess treatment effects.

l° (Total intervals target behavior occurred ÷ Total intervals observed) × 100 = % of intervals of target behavior

• Rate: This formula will help you determine on average how much time passes between the occurrence of targeted behaviors (interbehavior interval). Use this information to help set the frequency of noncontingent escape.

l° Total minutes observed ÷ Total intervals target behavior occurred = Rate or average interbehavior interval

Form 6.16 n Formulas for Determining Increases or Decreases in Frequency of NCE

• Formula for 10% increase in time between negative reinforcement.

• Current reinforcement interval × 1.10 = (10% increase in time)

• Formula for 5% increase in time between negative reinforcement.

• Current reinforcement interval × 1.05 = (5% increase in time)

• Formula for 10% decrease in time between negative reinforcement.

• Current reinforcement interval × 0.90 = (10% decrease in time)

• Formula for 5% decrease in time between negative reinforcement.

• Current reinforcement interval × 0.95 = (5% decrease in time)

ADDITIONAL RESOURCES Coleman, C. L., & Holmes, P. A. (1998). The use of non-contingent escape to reduce disruptive behaviors in children with speech delays. Journal of Applied Behavior Analysis, 310, 687–690. Kodak, T., Miltenberger, R. G., & Romaniuk, C. (2003). The effects of differential negative reinforcement of other behavior and non-contingent escape on compliance. Journal of Applied Behavior Analysis, 36, 379–382. O’Callaghan, P. M., Allen, K. D., Powell, S., & Salama, F. (2006). The efficacy of non-contingent escape for decreasing children’s disruptive behavior during restorative dental treatment. Journal of Applied Behavior Analysis, 39, 161–171. Vollmer, T. R., Marcus, B. A., & Ringdahl, J. E. (1995). Non-contingent escape as treatment for self-injurious behavior maintained by negative reinforcement. Journal of Applied Behavior Analysis, 28, 15–26.

311

AppendixCipani EO School Behavioral Interview Form (can be copied by owner of this text with permission for use in FBAs)

ti0005

Deprivation Establishing Operations (EOs)1

1 Please read the section on this form detailed in Chapter 2 before filling out this form to ensure correct administration and use (to not administer according to instructions in Chapter 2 makes obtained data possibly invalid and misleading). Only the owner of text can reproduce these sheets with permission.

ti0010

Rating H/D/W Attention EO

When the student requests or demands adult (i.e., instructional staff) attention and is told to wait?

When the student desires attention and the adult is unavailable for such?

When an adult withdraws attention from this student and/or attends to others (classmates, peers)?

When peers or certain classmates are present (vs. the absence of such behaviors when they are not present)?

td0010td0015

td0020td0025td0030

td0040td0045

td0050td0055td0060

td0070td0075

A

Rating H/D/W Tangible EO-Consumable

When the student requests or demands a desired consumable item and is told to wait?

When the student desires a preferred consumable item and the item is temporarily unavailable (and/or is told “No”)?

When the student desires a preferred consumable item and is given a different item (e.g., redirected)?

When others (classmates, peers) get the consumable item and this student does not?

When the student does not get enough of the consumable item (e.g., wanted two cookies and got only one, finished item and wanted more)?

td0085td0090

td0100td0105

td0115td0120

td0130td0135

td0145td0150

td0160td0165

312 Appendix A

Aversive EOs2

2 Please read the section on this form detailed in Chapter 2 before filling out this form to ensure correct administration and use (to not administer according to instructions in Chapter 2 makes obtained data possibly invalid and misleading). Only the owner of text can reproduce these sheets with permission. Behavioral objectives that interface with the results of the Cipani EO School Behavioral Interview Form are available from the author at [email protected].

ti0020

Rating H/D/W Unpleasant Social Situation EO

When the student is presented with any social or task demand (i.e., problems in compliance to simple adult/teacher instructions)?

When the student is in circumstances that involve following the rules of a game or play activity?

When the student is criticized or corrected during instructional task or chore?

When the student receives social disapproval from an instructional staff person or peer (for behavior, manner of dress, way of talking, etc.)?

When the student receives a negative consequence for his or her behavior or is threatened/warned with one (e.g., is told he or she will lose some free time after lunch for some behavior)?

When the student is interacting with certain peers or instructional staff members?

When the student is in social situations with too many people?

When the student is in social situations with novel people?

When the student is in social situations with a member(s) of the opposite gender?

When the student is in an argument with a peer/friend/other?

When the student is in novel social situations or settings?

td0260td0270

td0275td0280td0285

td0290td0295td0300

td0305td0310td0315

td0320td0325td0330

td0335td0340td0345

td0350td0355td0360

td0365td0370td0375

td0380td0385td0390

td0395td0400td0405

td0410td0415td0420

td0425td0430td0435

Rating H/D/W Tangible EO-Activity, Event

When the student requests or demands a desired event or activity and is told to wait?

When the student desires a preferred event or activity and such is temporarily unavailable (and/or is told “No”)?

When the student desires a preferred activity or event and is directed to an alternate activity (redirected)?

When others (peers) get the desired activity or event and this student does not?

When the student does not get a sufficient amount of time with the desired activity (e.g., wanted a half hour of computer time and got only 10 minutes; activity ended and student told to transition to a less desired activity)?

td0170td0175td0180

td0185td0190td0195

td0200td0205td0210

td0215td0220td0225

td0230td0235td0240

td0245td0250td0255

Cipani EO School Behavioral Interview Form 313

Rating H/D/W Relatively Lengthy Task EO

When the student is presented with instruction, seatwork, or an instructional activity that is relatively lengthy (e.g., 1 hour in length when the current duration for active engagement is 10 minutes) for him or her?

When the student is presented with a nonacademic task that is relatively lengthy (e.g., 1 hour in length when the current duration for active engagement is 10 minutes) for him or her?

td0440 td0445 td0450

td0455 td0460 td0465

td0470 td0475 td0480

Rating H/D/W Relatively Difficult Task EO

When the student is presented with instruction, seatwork, or an instructional activity that is relatively difficult (lacks prerequisites or skill in its entirety) for him or her?

When the student is presented with a nonacademic task that is relatively difficult (lacks prerequisites or skill in its entirety) for him or her?

td0485 td0490 td0495

td0500 td0505 td0510

td0515 td0520 td0525

315

AppendixWhy Artie Can’t Learn1

A teacher presents the following lesson in a hypothetical preschool classroom in everyday Americana:

Teacher: Today we are going to learn about prepositions. I have a large box in the middle of the room. Does everyone see the box? We will use that box. Listen carefully. When I call your name, stand up and see if you can follow my direction. I want Sarah to stand up. (Sarah stands up.) Good, Sarah, I want you to stand in front of the box. Show us where “in front of ” the box is.

Sarah: (Demonstrates correct behavior by getting in front of the box; Artie is looking at a discolored spot on the drop ceiling.)

Teacher: Good, Sarah. You stood in front of the box. You did not stand behind the box. Class, did Sarah stand on the box?

Most of class: No. Teacher: Where did Sarah stand? Kid raising hand: She stood in front of the box. Teacher: Let’s try another one. Bobby, stand up. (Bobby complies and stands

up.) Good, Bobby. I want you to stand behind the box. Show us where to stand so that you are behind the box (vocal emphasis on “behind” is made).

Bobby: (Walks to the box and stands behind it.) Teacher: Very good, Bobby. You stood behind the box. You did not stand in

front of the box. Class, did Bobby stand inside the box? Most of class: No. Teacher: Where did Bobby stand? Kid raising hand: He stood behind the box. Teacher: (Stops lesson seeing Artie is still looking at the ceiling, and has not paid

attention during this entire time.) Artie, you need to pay attention. How can you learn where “in front of ” is if you don’t watch?” (Artie still does not attend)

Teacher: (Moves closer to Artie.) OK. Artie, get behind the box.

B

316 Appendix B

Artie: (He gets up and piles inside the box.) Teacher: Now see, Artie, if you were listening, you would have gotten behind

the box, instead of inside the box. Now pay attention so you can learn the difference between “inside,” “in front of,” and “behind.”

In reviewing this scenario, ask yourself which students profited from this lesson.

ll Did Sarah learn? ll Did Bobby learn? ll Did Artie learn? ll Why did Artie not learn?

Perhaps you have seen children like Artie in preschool classes, that is, children who do not attend while a lesson is being presented. Attending skills in the early grade levels is critical to academic success. Listening to the teacher as well as observing the teacher and other students demonstrate a skill, such as placing an object in a box versus outside the box, is critical to skill acquisition in preschool. One-to-one direct teaching, prompting, and requiring child attention is not usually provided. Rather, instruction is geared toward the entire group via the oral presentation of a lesson. In the previous scenario, children who watched their classmates get up and place themselves in a position relative to the box will hopefully learn the relational concept involved in prepositions. The ability to acquire skills by observing others has been termed observational learning. Much of what young children learn is through observation. If a child does not attend in the first place, it is hard to learn observationally.

Artie’s ability to profit from this form of instruction is very unlikely. He does not attend to the verbal presentation by the teacher. He does not observe his classmates performing the requested behavior. Subsequently, he will probably be unable to imitate those actions when asked. If his ability to observe and imitate the behavior performed by another child or the teacher does not improve, will he be any further along in his acquisition of prepositional relations?

Looks Good, but Smells Bad! While traditional forms of teaching/instruction for preschool children may look great, the efficacy for young children with autism is minimal at best. Given the previous scenario, is it wise to deploy an instructional approach whose requisite for success is the attending skills of the child? Does that make sense for children like Artie, when their attending skills are minimal to nil? Here is a hypothetical example of looking good, but smelling bad.

The Itsy-Bitsy Spider. It is the start of the class time, and all the children arrive in their special education preschool classroom. The five boys and girls in the class have autism, with severe adaptive and cognitive deficits. Only one of them says words, but not in any useful or functional sense (repeating “mama” every so often). The class is heavily staffed, with a credentialed teacher and two instructional aides.

It is the beginning of the day, and that means “the morning circle,” a staple in everyday preschool programs for language-capable children. Such a format in a regular preschool class with language-capable children conjures up an image of children learning though doing and saying. But this is a special education class with language-deficient children. The teacher walks over to the CD player and pushes the play button, while all five children are seated in a semicircle around the teacher’s chair at the front of the carpet area. The instructional aides, whose job is to help keep the children in their seats (no small feat), are seated behind the children. The music comes on:

“The itsy bitsy spider, went up the water spout . . .”

Any observer to this class sees the following. Of the five boys and girls in the class, four of them at any one time are engaged in some other distracting activity, such as hand weaving, turning around, tantrum behavior, or getting out of their seats. All the children seem oblivious to the concept that this is a learning activity and continue to not attend as the

Why Artie Can’t Learn 317

music plays on. One boy makes eye contact with the teacher for awhile. But within a second he gets up and starts jumping around, upon which time he is directed to sit back down by the nearest adult.

The aides are in rhythm and sing their hearts out with the lead of the teacher. But what also is apparent is the lack of vocal responding from the five students. Of course, one might expect that, given four of them have no capability to produce intelligible words. Even the girl who does speak upon occasion does not join in, but rather seems interested in the knot in her shoelaces. Are the children supposed to be singing? One could make a convincing argument that the production of words via sing-song is a great way to enhance a young child’s sophistication in language. But there is a caveat: you have to be able to produce words and actively engage in the activity to learn.

A naïve conception of many personnel who work with children with severe disabilities is that repeated practice using this group approach will eventually work. They believe that children like Artie just take longer to learn. Hence, they do these group activities month after month, year after year. When asked, these people proclaim, “He will get it eventually, it just takes more time and patience.” Four years later, Artie (now age 8) still does not sing the first five words of the “itsy bitsy spider.” What did they mean by getting it eventually?

Why Is Group Daily Practice Not the Answer for Artie? An interesting series of experiments sheds light on this learning enigma with children with autism. Lovaas and his colleagues addressed why children with autism often took a long time to acquire a target skill, even when  being directly taught by an experienced behavior therapist (Lovaas, Koegel, & Schreibman, 1979). These researchers conducted a number of experiments that included two phases. In the first study, the following two phases were implemented (Lovaas, Schreibman, Koegel, & Rehm, 1971). In the first phase, each child was taught to press a bar when one target stimulus (called a discriminative stimulus) was presented and not to press the bar in its absence. The discriminative stimulus comprised three elements (called a compound stimulus): (a) a moderately bright visual light (red floodlight), (b) an auditory stimulus (white noise sound), and (c) a tactile event (pressure cuff on child’s leg). Here is what this phase of the study looked like. Imagine that the child is in the experimental room with the therapist. When all three of these elements are presented simultaneously, the child was taught to press a bar. The occurrence of the child pressing the bar when all three elements are presented would result in food reinforcement. No food reinforcement was presented for bar pressing in the absence of this presentation. The research study encompassed training on this simple discrimination to three groups of children: (a) “normal” children, (b) children with mental retardation, and (c) children with autism.

Children in all three of the groups acquired this discrimination. All children pressed the bar when all three elements were presented simultaneously and did not press the bar in their absence. A reasonable person would assume that all these children had come to equate any of the elements as the basis for responding. In other words, the children attended to all three elements (light, white noise, and pressure on leg) equally, and their responses were under control of any and all of these elements.

The second phase of the study tested that notion. In this phase, each element was presented in isolation to see whether its presence would evoke the bar press (this was called “single cue testing”). The single cue test involved 70 presentations of one of the elements (probably divided equally) to each child. The experimenter noted for each presentation whether the child pressed the bar when a given element was presented. For example, in this phase, the white noise would come on and then end. Sometime later, the light would come on and then be terminated. The numbers of times the child pressed the bar in the presence of each element (light, white noise, and pressure cuff on the leg) was tabulated.

The results were astounding. The nonhandicapped children (called “normal” in the study) responded to each of the elements equally. In other words, whether the light, white noise, or pressure to the leg was presented singly, the child pressed the bar. In contrast, the children with autism primarily pressed the bar to just one of the elements; three of these children responded to the auditory stimulus, while two would press the bar only when presented with the red floodlight. None of the children with autism responded to the pressure cuff. This “restricted focus” characterized these children when compared to nonhandicapped

318 Appendix B

same-aged peers.2 Had the autistic children attended to only one of the elements to the exclusion of the other two during phase I training? It seemed so! But what does it mean?

What Are the Implications for Teaching Children with Autism? In one word: profound! First, to get the attention of a child with autism requires instructional procedures that make that a requisite of their attention for task presentation. Hence, even small group teaching strategies do not ensure that attention because it is hard to get initial and sustained attention when working with several children at once. If the children are not attending to your instructional presentation, bet dollars to dimes that they are not going to learn the task, irrespective of how much practice they are given every day. However, even if you get attention to an instructional command in one-to-one training, the child may still not learn the skill. If the child attends to an irrelevant piece of the instruction, even repeated practice will be futile in acquiring the skill. An example will best illustrate this.

Let us say you are trying to teach a little girl with autism to discriminate a request for a coat versus a request to get shoes. You will attempt to teach her to respond differentially to these two different commands, “Pick up the coat” and “Pick up the shoes,” as they both are lying on the bed. Although we see this as a fairly simple skill to acquire, you should now see that these commands comprise multiple elements. In addition to nonverbal actions that may or may not accompany these commands, there are also four words for each command.

Given these two commands, what element (or feature) tells you what behavior is being requested? In other words, what is the most critical element to focus on in order to get this right? The answer: the last word of each command, that is, “coat” versus “shoes.” Remember that, while you may believe the child is attending to all the elements of these commands, if she is autistic, she is probably attending to one element within the compound stimulus. If she focuses on the last word uttered and discerns the different syllables involved in each (“coat” versus “shoes”), she will learn this task.

But suppose she focuses on the word “pick.” Unfortunate for this child, the word “pick” is inherent in both commands. Therefore, unless she attends to a different element, she will be able only to guess which article of clothing to pick up. Correcting her mistake will prove fruitless. She will continue to not learn the task, despite practice day after day on that skill. Her attending to only one element in this compound stimulus will keep her from mastering this simple discrimination. In my (E.C.) clinical work with children with autism, it is often the case that they ignore all the different unique phonemes of the English language that compose words.

This results in the illusion of learning when they respond correctly to a designated task. Let me illustrate with the previous teaching example. Suppose the tone or voice volume with which the trainer or parent says the first command, “Pick up the shoes,” is markedly louder than the command “Pick up the pants.” The child may look like she has learned the difference between the two commands, but again it is just an illusion. When she hears a loud voice volume, she picks up the shoes. When she hears the teacher present a command in a softer voice, she picks up the coat. She makes her decision on what to pick up by listening intently to the voice volume, not the syllables of the last word.

It is now obvious what is wrong with this manner of learning. When other people do not use the same differential voice volume for each of these two commands, the child appears to have not learned at all. Again, what she actually learned is the louder voice volume means pick up the shoes, softer volume means pick up the coat.

Let us look at another, everyday teaching example and examine the ramifications of restricted focus. Here are two white cards that a teacher might use to teach a child to learn to read the printed numbers 1 versus 2.

1 2

Why Artie Can’t Learn 319

How does any child learn the difference? By the teacher saying “one” when presented with the card that has number 1 on it and “two” for the other card? By attending to the difference between the form of the number 1 versus the number 2, right? The child might learn that with a vertical line, he or she says “one” when asked what number this is. In contrast, the number with the curve is the element the child uses to respond differently, that is, he or she says “two.” Attending to those single elements with the numbers 1 and 2 will be fine as long as the lesson does not proceed to other numbers. When the instructional program proceeds to other numbers that share a similarity with those elements (e.g., “4” with the number 1 and “3” with the number 2), life will become more difficult. What might the child say when asked what the number “3” is? You guessed it. He or she might say “two.” If the child is to acquire more sophistication with reading numbers, he or she will have to make the selection on the basis of critical differences in the other elements of these two numbers.

Let us complicate this example even further. Suppose the child does not attend to the form of the numbers. He or she ignores those elements. Rather, the child just sees two rectangle- shaped cards with something printed on each. Looking at the shape of the cards that have the printed number will be no help in responding correctly. Over time, the child demonstrates differential responding to these two numbers. Can we assume that he or she has learned these two numbers? Such responding may just be an illusion of skill acquisition. Suppose, as the school year wears on, the card with the number “1” gets ripped at the corner (whereas the card with the number 2 is not ripped at the corner). The child begins to use that difference as a basis for answering “one” when presented that card, and “two,” when presented with the nonripped card. Of course, a new set of cards with these two numbers makes the skill “go away.” You can see that the “restricted focus” to a single, unfortunately irrelevant element in this task will be to the child’s detriment in acquiring the skill of reading numbers.

What do these examples demonstrate? As long as the child with autism continues to focus on one (possibly irrelevant or redundant) element within any given compound stimulus, the concept you are trying to teach will never be learned. You could give weeks, months, or years of teaching to develop a target skill and get nowhere. With children with autism, it matters how you teach, not just that you teach. All teaching strategies are not created equal!

Notes 1. Taken in whole from: Cipani, E. (2008). Triumphs in early autism treatment (pp. 175–183).

New York, NY: Springer Publishing. Used with permission. 2. Termed stimulus overselectivity in the research study.

REFERENCES Cipani, E. (2008). Triumphs in early autism treatment. New York, NY: Springer Publishing. Lovaas, O. I., Koegel, R., & Schreibman, L. (1979). Stimulus overselecting in autism: A review of research. Psychological Bulletin, 86, 1236–1254. Lovaas, O. I., Schreibman, L., Koegel, R. L., & Rehm, R. (1971). Selective responding by autistic children to multiple sensory input. Journal of Abnormal Psychology, 77, 211–222.

321

Abolishing operation, 16, 19–20, 26, 33, 96, 97, 144

Access mand, 144, 147, 152, 154–157, 185, 241–251

Analogue assessment, 15, 50, 70, 71, 72, 73–74, 77

Avoidance functions, 6, 125

Behavioral interviewing, 40, 50–57, 58, 72

Chain interruption, 131, 144–145, 146, 148, 149, 150, 151, 152,153, 157, 162, 163, 164, 165, 166, 167, 188, 206, 219, 232, 236, 243, 257, 267, 277, 289

Clinical cases Breakfast is down the corner, 103 Child without a conscience, 26–32 Class clown: it’s elementary, 110 Diving onto the fl oor, 133–136 Do not argue! 157–158 Elopement, 111–112 Enough is enough, 127–128, 172 Going Gandhi, 127 Got context data? 94 Head bang from a toothache? 122 Head start and the tricycles, 62 He likes to be restrained, 113 Hiding, 123 Hitting the table and social mediation, 127 I am hungry now, 112–113 I am on the phone! 106–107 I hear voices, 77 I like messages! 114 I’m bored, 127, 171 I need a break, 119, 166, 167 I need a break, my head is swelling,

128, 175 Intimate disclosure, 38–39 It’s attention I desire, 77–78

I want your attention, NOW!, 106 I will kill myself ! 107–108 Making many beds, 119–120 Potato chips: Bet you can’t have just one,

113–114, 161 Privacy please, 149 Psychotic student? 167 Pushing and shoving, 145–146 School placement (and Mom’s job) in

jeopardy, 161 Self-induced vomiting, 85–86 Shut up and leave me alone! 124 Spinning, 123 Talking is good, 98, 150–151 Th e 20-minute child, 128, 174 Voices make me laugh, 98–99 When I say “No!”, 75–76 Will steal for social attention, 108–109

Compliance, 6, 9, 10, 18, 27, 28, 41, 55, 60, 76, 82, 83, 93, 133, 161, 177, 231, 253

Core curriculum, 130 Counseling, 3, 220, 243

Delay of Gratifi cation training, 142, 144, 145, 152, 159, 162

Descriptive analysis, 50, 57, 58, 60, 105, 123, 134, 220

Destructive behavior, 10, 100, 127, 161, 162, 169–170, 171–172, 234

Group contingency, 157–158, 196–203

Establishing operation, 14, 15–18, 20, 92, 95, 97, 102, 116,125, 135, 140,

Extinction, 149, 152, 153, 155, 156, 159, 161, 168–170, 175, 185, 199, 200, 206, 211, 212, 216–217, 219–224, 231, 232, 241, 242, 243, 244, 246, 248, 255

Functional behavior-analytic approach, 3, 4

Function-based diagnostic categories Direct access, 96–104

Immediate sensory stimuli, 96–101

Tangible reinforcer, 101–104 Direct escape, 114–122

Aversive physical stimuli, 121–122 Diffi cult tasks, chores, instruction,

120–121 Lengthy tasks, chores, instruction,

117–120 Unpleasant social situations, 116–117

Socially mediated access, 104–114 Adult/staff attention, 105–109 Peer attention, 109–110 Tangible reinforcer, 110–114

Socially mediated escape, 122–132 Aversive physical stimuli, 131–132 Diffi cult tasks, chores, instruction,

129–131 Lengthy tasks, chores, instruction,

125–129 Unpleasant social situations,

122–125 Function-based diagnostic classifi cation

system Utility of, 83–84

Incident method, 41–42 In-situ hypothesis tests, 50, 77–79 Instructional mismatch, 120–121, 129, 179

Multifunctional, 27–32

Need for intervention, 33–34 Noncontingent reinforcement, 171, 177, 196,

198, 200–213

Index

Performance discrepancy analysis, 74–76, 79

Premack Principle, 152, 162, 163, 166, 167, 168, 174, 231, 256

Replacement behavior option, 145, 164, 170, 171,181, 186, 241, 245, 277, 278, 287, 289

Reverse Premack principle, 152, 153, 157, 172, 175

Scatter plot data, 50, 68–70

Time out, 3, 6, 10, 13, 27, 52, 94, 99–100, 102, 114, 115, 116, 125, 133, 161, 162, 172, 278, 279, 282

Tolerance training, 163, 166, 168, 173, 174, 255, 256, 264, 268, 279

Trigger analysis, 46, 48, 50, 59, 60, 61–67

Wacky contingencies, 26, 118–119, 126

322 Index