Transcript of "Reducing escape behavior and increasing task completion with functional communication training, extinction and response chaining lalli"
JOURNAL OF APPLIED BEHAVIOR ANALYSIS 1995, 282 261-268 NUMBER3 (FALL 1995) REDUCING ESCAPE BEHAVIOR AND INCREASING TASK COMPLETION WITH FUNCTIONAL COMMUNICATION TRAINING, EXTINCTION, AND RESPONSE CHAINING JOSEPH S. LALLI THE UNIVERSITY OF PENNSYLVANIA AND SEAN CASEY AND KELLY KATES CHILDRENS SEASHORE HOUSE The effects of functional communication training, extinction, and response chaining on 3 sub- jects escape-maintained aberrant behavior were evaluated using a multielement design. Func- tional communication training consisted of teaching subjects a verbal response that was func- tionally equivalent to their aberrant behavior. Subjects initially were allowed to escape from a task contingent on the trained verbal response. In subsequent treatment phases, escape was contingent on the trained verbal response plus the completion of the specified number of steps in the task (response chaining). The number of steps was increased until a subject completed the task to obtain a break. Results showed that the treatment reduced rates of aberrant behavior and that the chaining procedure was effective in decreasing the availability of escape. DESCRIPTORS: extinction, functional communication training, response chaining, escape behavior, task completion In the treatment of aberrant behavior, func- ferred items (Bird et al., 1989; Fisher et al.,tional communication training (FCT) is a two- 1993; Wacker et al., 1990).step process. First, the therapist identifies the One potential benefit of FCT is that an in-target behaviors operant function. Second, the dividual can regulate delivery of the reinforcertherapist reinforces an alternative response with to a greater degree when compared to treat-the same consequence as that produced by the ments that rely solely on the passage of timeaberrant behavior. FCT thus weakens the ab- (e.g., response-independent reinforcement),errant response-reinforcer relation by providing time plus the absence of aberrant behavior (e.g.,the reinforcer for inappropriate behavior con- differential reinforcement of other behavior;tingent on the alternative response (Carr, DRO), or a predetermined performance re-1988). Researchers have used FCT as part of a quirement (e.g., task completion). However,treatment package to reduce aberrant behavior this benefit is compromised to the extent thatmaintained by attention (Carr & Durand, the reinforcer is not available immediately (e.g.,1985; Durand & Carr, 1991; Lalli, Browder, a snack before a meal) or may not be in theMace, & Brown, 1993), escape (Bird, Dores, best interest of the individual (e.g., escape fromMoniz, & Robinson, 1989; Carr & Durand, self-care routines). For example, in the treat-1985; Durand & Carr, 1991; Fisher et al., ment of escape-maintained behavior, therapists1993; Wacker et al., 1990), or access to pre- have sometimes terminated an ongoing task im- mediately when the subject emitted the trained escape response (Bird et al., 1989; Fisher et al., We thank the reviewers for their helpful comments on 1993; Wacker et al., 1990). Thus, althoughearlier drafts of this manuscript. Reprints may be obtained from Joseph S. Lalli, Chil- FCT may result in decreased rates of aberrantdrens Seashore House, 3405 Civic Center Blvd., Phila- behavior, it may also disrupt an ongoing activitydelphia, Pennsylvania 19104. and limit teaching opportunities. For FCT to 261
262 JOSEPH S. LALLI et al.be a viable treatment for escape-maintained be- of aberrant behavior during instructional activ-havior, therapists must use it in a way that can ities. Subjects admissions were sequential.maintain treatment effects while improving par- Joe was 10 years old with moderate mentalticipation in the required activity. retardation and was admitted for treatment of To address this concern, Bird et al. (1989) his self-injurious behavior. Joe interacted withand Fisher et al. (1993) gradually increased the others using utterances and responded to hisresponse requirements before their subjects name and some words. He was ambulatory, fol-could escape with the trained verbal response. lowed a few one-step directions, and could feedBird et al. increased the number of task steps himself but he required physical prompting torequired for completion before a subject could complete his other self-care activities. Jen wasexchange a token for a 60-s break; the initial 15 years old with moderate mental retardationincrease occurred after 6 weeks of FCT training, and autism, and she was admitted for treatmentand subsequent increases occurred at 3-week in- of her self-injury. She interacted with others us-tervals. Fisher et al. gradually increased the ing one-word utterances and responded to fa-number of instructional requests presented to a miliar names, objects, and activities. Jen wassubject from 2 to 26 before signing produced a ambulatory, followed one-step directions, and30-s break. Both studies successfully maintained independently completed self-care activities.low rates of aberrant behavior as performance Kim was 13 years old with moderate mentalrequirements increased. However, neither study retardation and autism, and was admitted forprovided detailed descriptions of the proce- treatment of her aggressive behavior. She inter-dures. acted with others using utterances and gestures In the present study, we extended this line of (pointing), and responded to her name and oth-research by evaluating the effects of response er familiar names, objects, and activities. Kimchaining following the implementation of FCT. was ambulatory, followed one-step directions,We taught subjects an alternative escape re- and demonstrated adequate fine and gross mo-sponse and then added a response chaining pro- tor responses for participation in self-care rou-cedure to increase their participation in the tines.task. We combined these treatment procedures All sessions were conducted individually inwith extinction throughout the study. Our ob- one of two therapy rooms (3 m by 3 m), andjective was to first teach a subject to escape task- observers recorded data from behind a one-wayrelated activities with a socially appropriate re- mirror. A therapist and subject were presentsponse, and then to teach a subject to tolerate during sessions. Two 1 5-min sessions were con-a delay (i.e., an increase in the performance re- ducted daily 5 days per week, with a minimumquirement) prior to obtaining a break from the of 120 min between sessions.task. Dependent Variables and Data Collection Self-injury was defined as forceful contact of METHOD ones head or mouth against an object Joe) or closure of upper and lower teeth on ones handSubjects and Setting den). Aggression was defined as forceful hitting Three individuals admitted to a hospital in- or throwing objects at others (Kim). Appropriatepatient unit specializing in the treatment of se- verbalization was defined as a subject indepen-vere problem behavior participated. All were en- dently giving the therapist an index card withrolled in the units special education program "BREAK" Joe), saying "no" Jen), or movingthroughout their admission. The teacher re- ones head horizontally to indicate "no" in re-ported that each subject engaged in high rates sponse to a therapists request (Kim). In the
TREA TMENT OF ESCAPE BEHA VIOR 263 FCT plus extinction with response chaining phases (FCT plus extinction with responsephases, appropriate verbalizations were defined chaining) consisted of gradually increasing theas the subject independently requesting a break response requirement prior to obtaining escapeafter completing the task requirement (i.e., on from the task.a fixed-ratio, FR, schedule). Compliance wasdefined as independently initiating a task within Functional Analysis 10 s of the therapists request. Data were also We assessed the subjects aberrant behaviorcollected on the therapists instructions, praise, under demand and play conditions, based onand withdrawal of instructional materials to procedures described by Iwata, Dorsey, Slifer,monitor procedural fidelity. Bauman, and Richman (1982/1994). We se- Observers used a computerized event-record- lected tasks from the subjects educational plansing procedure for all topographies (Repp, Har- and developed 16-step task analyses for useman, Felce, VanAcker, & Karsh, 1989). We throughout the study. During the demand con-converted subjects appropriate verbalizations dition, the therapist presented an instruction toand compliance to percentage of requests re- the subject once every 30 s (approximately 16sponded to independently with the respective per session), provided descriptive praise for cor-responses. A second observer independently col- rect responses, and provided a 30-s time-outlected data during an average of 30% of the from the task (escape) contingent on the oc-sessions, equally distributed across all phases currence of aberrant behavior. During the playand subjects. Interobserver agreement was de- condition, the therapist provided the subject ac-termined using the "reliable" program (Repp et cess to preferred items, delivered neutral com-al., 1989). Occurrence agreement was scored ments every 30 s, and did not respond to ab-when two observers recorded the onset of a tar- errant behavior.get behavior within 2 s of each other. Occur-rence agreement averaged 88% (range, 83% to Treatment Conditions97%) across topographies, phases of the study, Baseline. Baseline conditions during the FCTand subjects. Procedural fidelity data showed plus extinction evaluation were the same asthat the therapist correctly carried out the pro- those of the functional analysis demand condi-cedures on an average of 93% of the opportu- tion (described above) with one exception. Dur-nities across all subjects. ing the baseline condition, the therapist provid- ed descriptive praise contingent on the trainedExperimental Designs and Sequence verbal response ("no") and restated the instruc- The teacher reported that the subjects en- tion. That is, trained verbal responses weregaged in aberrant behavior exclusively during placed on extinction during these conditions.instructional activities. Therefore, we initially FCTplus extinction. The therapist presentedassessed the subjects aberrant behavior via a a request to the subject as in the functionalfunctional analysis to verify the hypothesized es- analysis demand condition. However, the ther-cape function. Conditions were presented dur- apist also said, "If you do not want to working 15-min sessions in a multielement design. now, say no [or the other verbal responses]." The second phase of the study began with an The therapist allowed the subject 10 s to emitevaluation of FCT plus extinction using a mul- the trained verbal response independently. Con-tielement design in which FCT plus extinction tingent on noncompliance, the therapist provid-conditions alternated with baseline conditions. ed either physical prompts Joe) or modeledWe paired each condition with a different ther- prompts den and Kim) for the appropriate ver-apist and setting to help subjects discriminate bal response. If aberrant behavior occurred dur-the conditions in effect. Subsequent treatment ing a trial, the therapist waited 10 s after it
264 JOSEPH S. LALLI et al.ceased, then prompted the verbal response. The rant behavior that occurred during the task. Iftherapist provided descriptive praise and a 30-s the subject did not ask for a break within 10 stime-out from the task contingent on the verbal of completing the criterion, the therapist saidresponse (independent or prompted). In this "Good, you finished. Do you want moremanner, the subject escaped each request con- work?" If aberrant behavior occurred after thetingent on the verbal response. subject completed the criterion, the therapist FCT plus extinction with response chaining. waited 10 s after it ceased, then repeated theThe objective of these conditions was to grad- above statement. The therapist immediatelyually increase the response requirement before provided a 30-s break contingent on indepen-the subject could request a break from task de- dent or prompted target verbal responses. Wemands. Thus, the FR designation refers to the initially established the criterion for a break asnumber of steps in the task that the subject was completion of one step of the task (FR 1) andrequired to complete before asking for a break subsequently doubled the criterion for the nextwas reinforced (i.e., FR 1 to FR 16). Escape phase after three consecutive sessions withoutwas contingent on completion of the required aberrant behavior.number of steps in the task and emission of thetrained verbal response. The number of requestsper session depended on the FR schedule in ef- RESULTSfect. For example, in the FR 1 phase, the ther- Functional Analysisapist presented 16 requests, with each request Response patterns were similar for the 3 sub-corresponding to one step in the task analysis, jects; that is, aberrant behavior occurred exclu-with a break allowable following the completion sively in the demand condition (Figure 1).of each step. In this manner, the subject com- These findings suggested that aberrant behav-pleted the entire task by the end of the session. iors were maintained by escape.In subsequent treatment phases, the therapistpresented progressively fewer requests based on FCT plus Extinctionthe FR schedule in effect (e.g., FR 2, eight re- Results presented in Figure 2 show lowerquests; FR 4, four requests), and the subject rates of aberrant behavior during the FCT plusreceived correspondingly fewer breaks. This extinction condition compared with the base-procedure continued until the therapist pre- line condition for each subject. Joes data showsented one request per session (i.e., FR 16), a gradual decrease in rates of self-injury, whichwhich required the subject to complete the en- eventually reached zero. By contrast, Jens andtire task before requesting a break. Kims data show more rapid reduction in rates During the response chaining phase, the of aberrant behavior. During the FCT plus ex-therapist provided a request to the subject, stat- tinction condition, Joes independent verbaliza-ed the criterion for earning a break, and pointed tions gradually increased from 0% to 69%, Jensto the instructional materials related to the increased from 38% to 81%, and Kims in-specified criterion. Contingent on the verbal re- creased from 25% to 88% of the therapists re-sponse, the therapist said, "Good saying no, but quests per session. Joes independent verbaliza-you have to do [task step] then you can ask for tions averaged 3% during the baseline condi-a break." Contingent on noncompliance, the tion (not graphically presented), and Jen andtherapist physically guided the subject to emit Kim never emitted the verbal response duringthe task-related response. The therapist praised baseline conditions. The subjects task-relatedcompliance, provided the level of assistance nec- compliance in the FCT plus extinction condi-essary (i.e., least-to-most prompt hierarchy) tions was zero, because escape was contingentduring the task, and did not respond to aber- on the trained verbal response. Task-related
TREA TMENT OF ESCAPE BEHAVIOR 265 Functional Analysis compliance in the baseline condition averaged 2.8- 3% for Joe, 13% for Jen, and 17% for Kim 2.4 (not graphically presented).wI- 2.0- FCT Plus Extinction with0 Response Chaining 1.6- Demand We observed low rates of aberrant behavior 0 1.2- for each subject during the initial FCT plus ex- 0.8 tinction with response chaining condition (FR 05 Play rJOE havior i 1, Figure 2). The subjects rates of aberrant be- 0.4 stayed low throughout the remaining 0.0 0 O . phases when performance requirements for ob- 1 2 tamning a break were increased. Interestingly, we 3 observed temporary increases in rates of aber- 2.8 Y rant behavior in each chaining phase for Jen 2.4 and Kim and for Joe in the first and third chaining phases. However, the subjects rates of 2.0w I-- aberrant behavior quickly decreased and re-z 16 mained stable throughout the phases. = 1.2 In the response chaining phases, subjects had the opportunity to independently request a X 0.8 break following completion of the FR schedule. 0.4 JEN For example, in the FR 1 phase, subjects had 16 opportunities (i.e., following each completed 0.0 0 -0 =v request), considered as trials, to request a break I 2 3 independently. The number of trials decreased 0.9- proportionately across subsequent FR phases. 0 Therefore, data on appropriate verbalizations inz the response chaining phases reflect the per- s centage of trials in which the subjects indepen- 0.6- dently requested a break following completionz of the FR schedule. Subjects always responded 0.3- to the therapists statement "Do you want moreC, work?" by saying "no." However, these werea, KIM considered to be prompted responses and are not graphically presented. Joes independent 0.0 0 -0 ° verbalizations showed a gradual increase across 1 2 3 response chaining phases before eventually av- SESSIONS eraging 100% in the FR 16 phase. By contrast, Figure 1. Responses per minute across asse Jens and Kims independent verbalizationsditions. ssment conl showed a more rapid increase. Jens and Kims independent verbalizations averaged 100% by the fifth session of the FR 2 phase and the third session of the FR 4 phase, respectively. During the response chaining phases, we ob- served an increase in subjects independent
266 JOSEPH S. LALLI et al. r - - FCT + EXT (WITH RESPONSE I (FRI(FR2)2) (FR4) 2.8 I 100 -W-BL (SIB) 2.4 2.0 4 1.2 941 5 1 1 t 60 I4 0p40 0.8 1 12 1 0.4- FCT + EXT I 0.0 FCTI (SIB) (TR) ) 4 812 16 20 24 2 MULTIELEMENT --- FCT + EXT (WITH RESPONSE CHAINING -----I c 3. ALUATION (Ri) (FR2) (FR4) (FRO) (FR16) 1 3.0 80 Figure 2.5 R 2.0 >~I I LU~~~~ c 40IIL 1.0 0 ~~~~~~~~~~~~~~~~~Nz UZ 20 0.0 0.5 12 18 Jj0E 24 30 36 54 a 2.0 -MULTIELEMENT r -- FCT + EXT (WITH RESPONSE CHAINING) A----- =fncioalcomuictinr EVALUATION ;(FR1) (FR (FR4) (FR8) (FR1 6) 100 1.6- 1.2 ~~~~~~~~~~~60 0.840 iKIM 0Q4- 0.0 1 4 8 12 16 20 24 28 32 36 SESSIONS Figure 2. Responses per minute of aberrant behavior and the trained verbal response during the multielementevaluation and FCT plus extinction with response chaining. ALT-R = appropriate verbalization; EXT = extinction;FCT = functional communication training; FR through FR 16 = task-related criterion for break across FCT plusextinction with response chaining phases.
TREATMENT OF ESCAPE BEHA VIOR 267compliance with requests compared with base- sponse probably has a shorter reinforcementline. During baseline, compliance was low and history than the aberrant behavior. To addressvariable. Joes compliance averaged 20%, 46%, this problem, we started functional communi-81%, 83%, and 100% across the response cation training immediately upon Jens andchaining phases (i.e., FR 1 to FR 16). Jens Kims admission to the hospital program. Wecompliance averaged 48%, 63%, 77%, 85%, initially taught Jen and Kim the appropriateand 100% across the response chaining phases. verbal response by presenting them with non-Kims compliance averaged 32%, 58%, 70%, preferred items and telling them to say "no" if80%, and 80% during response chaining con- they did not want the item. We started func-ditions. tional communication training for Joe during the first FCT plus extinction phase. Interesting- ly, a comparison of the FCT plus extinction DISCUSSION data showed that decreases in aberrant behavior Results of this study extend previous work on and increases in independent verbalizationsthe effectiveness of FCT plus extinction (Carr were obtained more quickly with Jen and Kim& Durand, 1985; Durand & Carr, 1991). Dur- than with Joe. We suggest that differences ining the FCT plus extinction conditions (with responding among the subjects might be a func-and without response chaining), we observed an tion of their individual histories with functionalinverse relationship between subjects appropri- communication training.ate verbal responses and their aberrant behavior A major focus of the present study was an(i.e., increased verbal responses and decreased evaluation of a response-chaining component asaberrant behavior). Low rates of aberrant be- a means of increasing compliance with task de-havior were maintained throughout the re- mands as well as reducing the availability of es-sponse chaining phases when the requirements cape. Although FCT plus extinction reducedfor obtaining a break were increased. In addi- rates of aberrant behavior initially, subjects didtion, we observed gradual increases in compli- not participate in the task because escape wasance with requests throughout the study. These contingent only on the trained verbal response.findings suggest that combining FCT plus ex- This highlights a potential limitation of FCT-tinction with response chaining in this manner allowing an individual to escape from a requiredmay be an effective way to maintain low rates instructional activity (even if contingent on aof aberrant behavior while increasing subjects socially appropriate response). To address thisparticipation in the task. problem, we started treatment sessions with in- Fisher et al. (1993) recently reported that structional requests and provided a break fromFCT plus extinction failed to reduce a subjects the task contingent on compliance with one re-rate of escape-maintained aberrant behavior and quest (i.e., FR 1) and the trained verbal re-speculated that treatment effects may be ham- sponse. We doubled the criterion for a breakpered by the temporal proximity between the across phases, with the criterion in the finalappropriate and aberrant responses. That is, the phase requiring the subject to complete the en-appropriate and aberrant behaviors may have tire task before earning a break. In this manner,formed a response chain. We addressed this subjects eventually completed the task in itsproblem by requiring the absence of aberrant natural progression. FCT plus extinction withbehavior for 10 s before providing a break con- response chaining gradually increased compli-tingent on the trained verbal response. A second ance with requests and maintained low rates ofconcern reported by Fisher et al. was the relative aberrant behavior.reinforcement histories for the appropriate and In the present study, initial treatment effectsaberrant responses. That is, the appropriate re- may have been a function not only of FCT and
268 JOSEPH S. LALLI et al.extinction but also of altering the establishing tion training with and without extinction and pun- ishment. Journal ofApplied Behavior Analysis, 26, 23-operation for escape. That is, by initially reduc- 36.ing the requirement for a break, the subjects Flannery, K. B., & Horner, R H. (1994). The relation-motivation to engage in escape behavior may ship between predictability and problem behavior foralso have decreased. Subsequently, the effective- students with severe disabilities. Journal of Behavioral Education, 4, 157-176.ness of the response-chaining component may Iwata, B. A., Dorsey, M. F., Slifer, K. J., Bauman, K E.,be attributed either to the gradually increasing & Richman, G. S. (1994). Toward a functional anal-response requirement (similar to that described ysis of self-injury. Journal ofApplied Behavior Analysis, 27, 197-209. (Reprinted from Analysis and Interven-by Zarcone, Iwata, Smith, Mazaleski, & Ler- tion in Developmental Disabilities, 2, 3-20)man, 1994) or to the fact that the instructional Lalli, J. S., Browder, D. M., Mace, F. C., & Brown, D.procedures (therapists instructions, task consis- K (1993). Teacher use of descriptive analysis data to implement interventions to decrease students prob-tency, and materials) increased the predictability lem behaviors. Journal of Applied Behavior Analysis,of the situation (Flannery & Horner, 1994; Lal- 26, 227-238.li, Casey, Goh, & Merlino, 1994). Lalli, J. S., Casey, S., Goh, H., & Merlino, J. (1994). Treatment of escape-maintained aberrant behavior N., with escape extinction and predictable routines. Jour- nal ofApplied Behavior Analysis, 27, 705-714. REFERENCES Repp, A. C., Harman, M. L., Felce, D., VanAcker, R., & Karsh, K L. (1989). Conducting behavioral assess-Bird, F., Dores, P. A., Moniz, D., & Robinson, J. (1989). ment on computer collected data. Behavioral Assess- Reducing severe aggressive and self-injurious behav- ment, 2, 249-268. iors with functional communication training. Amen- Wacker, D. P., Steege, M. W., Northup, J., Sasso, G., Berg, can Journal on Mental Retardation, 94, 37-48. W., Reimers, T., Cooper, L., Cigrand, K., & Donn,Carr, E. G. (1988). Functional equivalence as a mecha- L. (1990). A component analysis of functional com- nism of response generalization. In R Homer, R. munication training across three topographies of se- Koegel, & G. Dunlap (Eds.), Generalization and vere behavior problems. Journal of Applied Behavior maintenance: Life-style changes in applied settings (pp. Analysis, 23, 417-429. 221-241). Baltimore: Paul H. Brookes. Zarcone, J. R., Iwata, B. A., Smith, R. G., Mazaleski, J.Carr, E. G., & Durand, V. M. (1985). Reducing behavior L., & Lerman, D. C. (1994). Reemergence and ex- problem through functional communication training. tinction of self-injurious escape behavior during stim- Journal ofApplied Behavior Analysis, 18, 111-126. ulus (instructional) fading. Journal ofApplied BehaviorDurand, V. M., & Carr, E. G. (1991). Functional com- Analysis, 27, 307-316. munication training to reduce challenging behavior: Received August 15, 1994 Maintenance and application to new settings. Journal Initial editorial decision October 14, 1994 ofApplied Behavior Analysis, 24, 251-264. Revisions received February 16, 1995; March 20, 1995Fisher, W., Piazza, C., Cataldo, M., Harrell, R., Jefferson, Final acceptance April 20, 1995 G., & Conner, R. (1993). Functional communica- Action Editor, Brian Iwata