Discrete -Trial Functional Analysis of Problem Behavior and Functional Communication Training in Three Adults with a Dual Diagnosis of an Intellectual Disability and a Mental Illness LAURA C. CHEZAN

INTRODUCTION

Intellectual Disability Context Intellectual Disability Mental Illness Dual Diagnosis Problem Behavior

Context Cont’d Approach to Problem Behavior BEHAVIORAL INTERVENTIONS Behavior is influenced by environmental variables 1. Assess to identify function 2. Teach replacement behavior

Participants’ Selection All Participants Behavioral Assessment Intervention (FCT) Discrimination Assessment Functional Assessment Trial-Based Functional Analysis

PARTICIPANTS AND SETTINGS

Participants’ Selection Meeting with directors Informal observation of potential participants Meeting with staff members Selection of participants

Participants’ Characteristics Age Diagnosis Problem Behavior Antoine 27 moderate ID bipolar-disorder autism SIB repetitive verbal and motor behavior Rick 32 profound ID mood disorder physical aggression property destruction Tonya 23 severe ID psychosis NOS snatching food Note: ID = intellectual disability; SIB = self-injurious behavior

Assessment & Training Setting Settings Participant Type of Program Location Assessment & Training Setting Antoine day program rural dining room, instructional room Rick dining room, instructional room, hallway Tonya workshop urban work areas, dining area

ASSESSMENT AND ANALYSIS OF PROBLEM BEHAVIOR

Functional Assessment (FA) PURPOSE Collect information Background Information Topography of problem behavior Environmental variables Develop Hypotheses

FA – Methods and Outcomes Background information Record Review INDIRECT METHODS Definitions Hypotheses Interview (FAI; O’Neill et al., 1997) Temporal Relationships Verify Hypotheses ABC observations (Bijou, Peterson, & Ault, 1968) DIRECT METHODS

FA - DTFA Hypotheses Develop DTFA Test Hypotheses DTFA

DTFA - Conditions Antoine’s FA Hypotheses Rick’s FA Hypotheses Tonya’s FA Hypotheses Attention Automatic Reinforcement Attention Tangible 1 Tangible 2 Attention Tangibles

+ FA HYPOTHESIS ANTECEDENT (No Access to Reinforcer) CONSEQUENCE DTFA Components ASSESSMENT ( 2 min) + REINFORCEMENT (2 min) Present Antecedent  STOP if: (a) problem behavior (b) time elapsed Present Consequence hypothesized to maintain problem behavior

Automatic Reinforcement DTFA - Protocols Antoine Rick Tonya Attention Automatic Reinforcement Attention Tangible 1 Tangible 2 Attention Tangibles

Target Behavior and Recording System Problem Behavior No Response Occurrence or non-occurrence of the 2 responses (data sheet) Latency to first response

DTFA Implementation WHO? researcher, staff member, or behavioral consultant WHEN? naturally-occurring opportunities during typical routines throughout the day HOW? 1-5 trials per day under one or multiple conditions wait 10-15 min between trials

What Did We Anticipate? ASSESSMENT (No access to reinforcer) REINFORCEMENT (Access to reinforcer)  Problem behavior  Few or No Problem behavior

RESULTS

Latency to Problem Behavior

OUTCOME – Information about: Social Validity WHO? HOW? WHEN? Staff Questionnaire End of assessment OUTCOME – Information about: Significance of outcomes Appropriateness of procedures Continuation of procedures in the future

Social Validity Interfered with other responsibilities (M=1.5) Procedures were clear Interested in learning more (M=3.5) Took a long time (M=1.0) Easy to conduct (M=3.0) SD (1) SA(4) D (2) A (3)

DISCUSSION

Effectiveness of DTFA Clear patterns of behavior for all three participants Applicable to adults with dual diagnosis Few number of trials across conditions Variability in the topography of problem behavior and number of trials with problem behavior

Factors That May Have Influenced Variability in the Topography of Problem Behavior and Number or Trials with Problem Behavior Variations in stimulus control Individual motivation Fluctuation in the reinforcing value of certain people, items, or activities

Latency to First Occurrence of Problem Behavior Efficient and less intrusive way to determine the function of problem behavior Guide the delivery of reinforcement during intervention and increase tolerance for delayed reinforcement

Social Validity Implemented by staff members Embedded within typical routines Rated by staff members as: Easy to implement No time consuming

CONCLUSION

Conclusion DTFA was effective in identifying the function of problem behavior for all three adults

FUTURE STUDIES

Future research may include: Staff training for implementation of DTFA Replication of findings

FUNCTIONAL COMMUNICATION TRAINING (FCT)

FCT STEPS Identification of replacement behavior Teaching replacement behavior Identification of replacement behavior

Identification of Functionally Equivalent Replacement Behavior Reviewed DTFA results Consulted with staff members Identified a behavior that was easily discriminable and functionally equivalent Defined behavior

Teaching the Replacement Behavior Develop Instructional Procedures Assess Current Level of Performance Provide Instruction and Progress Monitoring Constant time delay Differential reinforcement Error correction BASELINE Protocol and Data Sheet INTERVENTION Protocol and Data Sheet 8 opportunities Daily routines Behavioral indication Researcher & staff Protocol

Target Behavior and Recording System Prompted Response or Problem Behavior Independent Response Occurrence or non-occurrence of the two responses for each opportunity (data sheet)

RESULTS

RESULTS

Discrimination Assessment Identify Example and Non-Example Discrimination Probes and Develop Protocol Administer Probes and Collect Data

Discrimination Probes 100% across all participants for both example probes and non-example probes

OUTCOME – Information about: Social Validity WHO? HOW? WHEN? Staff Questionnaire End of study OUTCOME – Information about: Significance of outcomes Appropriateness of procedures Continuation of procedures in the future

Social Validity Benefited from learning a new response and it reduces the frequency of PB Willing to continue the intervention (M=3.0) Interfered with other responsibilities (M=2.0) Easy to conduct (M=2.5) PB affected QOL (M=3.5) SD (1) SA(4) D (2) A (3)

DISCUSSION

Effectiveness of FCT Applicable to adults with dual diagnosis Mental illness may influence the acquisition pattern of some adults with dual diagnosis Effective in producing acquisition of a replacement behavior for all three adults

Factors That May Influence Different Acquisition Patterns Response competition Variations in stimulus control History of reinforcement

Discriminated Use of the Replacement Behavior Teach in the presence of behavioral indication Increases the likelihood of the precise use of replacement behavior

Social Validity Implemented by staff members Embedded within naturally-occurring opportunities Rated as: Beneficial for participants Relatively easy to implement No time consuming

CONCLUSIONS

Conclusions FCT produced acquisition of a functionally equivalent replacement behavior FCT produced discriminated use of the newly acquired replacement behavior

FUTURE STUDIES

Future research may include Relationship between behavioral indication and generalization of replacement behavior Staff training to identify teaching opportunities Replication of findings

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