1. Functionally analyzing problem behavior of young children
Gregory P. Hanley. Ph.D., BCBA-D
For more information go to:
Thanks to The Lake Ridge Program for supporting this and for Karen Chartier in oparticular who was instrumental in getting me in the right place at the right time.
Utah Neuropsychiatric Institute
Autism Intervention Program for Professionals
November, 2016

2. Why does problem behavior occur?
Causes are complex—first consider all of them
Then consider the causes that you can do something about
For me, those are the consequences of the behavior that serve as reinforcement
Why does problem behavior occur?
Well, causes are complex—first consider all of them. That is a bit overwhelming.
Then consider the causes that you can do something about.
For me, those are the consequences of the behavior that serve as its reinforcement

3. Working assumptions
If problem behavior is occurring with regularity…..
it is being reinforced
Please understand this fundamental concept: If problem behavior is occurring with regularity, it is being reinforced.
In other words, there is some improvement for the person with autism following problem behavior.
This is a simple but powerful working assumption

4. Antecedent  Behavior  Consequence
Establishing operation  Problem Behavior  Reinforcement
Mom attends to Throwing toys Mom’s attention
Sibling
Dad instructs to SIB Dad gives a little turn off Ipad more time on Ipad
Teacher instructs to Meltdown Teacher tries to calm
come off swing to do child with reminders of some DT work good events & starts to comply with child requests
Perhaps more attention from others is the reinforcer. Perhaps it is access to preferred toys or their Ipad. Or perhaps it is termination of something aversive or annoying like onerous academics or confusing social interactions.
We used to think that these reinforcers worked independently and almost exclusively. We now know that they do not, that these reinforcers often work in concert. In other words, the question used to be is problem behavior maintained by attention, tangibles, or escape. The question now is: Is problem behavior maintained by escape to attention and tangibles or some other combination and what are the specific materials and interactions that are to combined. It is now understood that there are more qualitatively rich reinforcers influencing problem behavior than the usual suspects of attention, tangibles, and escape. Things like access to stereotypy and preferred conversations, resumption of ongoing activities, having someone follow their lead, or gaining caregiver compliance with previously uttered requests. These too may serve as reinforcers for problem behavior.

5. Working assumptions
If problem behavior is occurring with regularity…..
it is being reinforced
We also assume that if severe problem behavior is occurring with regularity that the child lacks the important life skills of communication and toleration.

6. behavior analysts conduct functional assessments
To understand =
to determine the personally relevant outcomes and context that influence problem behavior
To understand some of the reasons why problem behavior is occurring or more specifically, to determine the personally relevant outcomes and context that influences problem behavior, behavior analysts conduct functional assessments.
Our main job with the functional assessment is to find the relevant reinforcers and the contexts that seem to potentiate those reinforcers.
behavior analysts conduct
functional assessments

7. Functional Assessment Process
Indirect Assessment Interview
Functional Analysis
Observe while manipulating
Descriptive Assessment
Observe
The functional assessment process has evolved to include some combination of indirect assessment, descriptive assessment, and functional analysis.
There are a variety of ways to conduct an analysis, but most ways conform to a particular way, at this point, I call this way…. the standard functional analysis.
Discovery
and
Demonstration

8. Fact: Functional analysis of problem behavior is well researched
435 studies with functional analyses and
981 distinct functional analyses
have been published
Beavers, Iwata, & Lerman, 2013; Hanley, Iwata, & McCord, 2001
and integral to the power of behavioral intervention
Larger reductions in problem behavior were evident
when a functional analysis was part of
the functional assessment process
Campbell, 2002; Kahng, Iwata, and Lewin, 2003, Hayvaert et al., 2012
The Functional analysis part of the process is well researched.
And the analysis is integral to the power of behavioral intervention. Meta analyses have shown that larger reductions in problem behavior were evident when a functional analysis was part of the functional assessment process.

9. Opinion: Functional assessment (including analyses) is
humane and dignifying
But I do it because it is how I would like to be treated were I to engage in severe problem behavior and not articulate why.

10. These two articles published this and last year in JADD and JABA respectively

11. Case Example (Gail, 3 yo, dx: PDD-NOS) Therapist: Nicholas Vanselow
Setting: Outpatient Clinic
Interview suggested that Gail engaged in meltdowns and aggression….
Problem
Behavior
I will describe the assessment for Gail, the 3 year old girl first. Gail had long beautiful dark hair, her mother always dressed her impeccably, and Gail was quite excellent with dramatic play. The main issue was that she had 5 to 10 meltdowns per day that lasted from a few minutes to about an hour and it was difficult for her mother to ever predict which one was coming. She also was very aggressive towards siblings and parents, and highly noncompliant with adult instructions.

12. Case Example (Gail, 3 yo, dx: PDD-NOS) Therapist: Nicholas Vanselow
Setting: Clinic
Interview suggested that Gail engaged in meltdowns and aggression….
when Mom was attending to other tasks or siblings….
Problem
Behavior
Context
(suspected establishing operations)
The interview suggested that Gail engaged in meltdowns and aggression primarily when Mom was attending to Gail’s sisters or other tasks like cooking.

13. Case Example (Gail, 3 yo, dx: PDD-NOS) Therapist: Nicholas Vanselow
Setting: Clinic
Interview suggested that Gail engaged in meltdowns and aggression….
when Mom was attending to other tasks or siblings….
in order to gain Mom’s undivided attention and to have Mom play with her and her most preferred toys.
Problem
Behavior
Context
(suspected establishing operations)
Outcome
(suspected reinforcers)
And that Gail engaged in meltdowns and aggression in order to obtain preferred items (usually toys) and he mother’s attention. When Gail’s mother was asked in the interview what she does to calm Gail down when she is having a meltdown her mother described how she would try to talk her out of it and distract her with interactive toys. This is where I like to point out that extraordinary behavior is usually influenced by very ordinary events and interactions.

14. Case Example (Gail, 3 yo, dx: PDD-NOS) Therapist: Nicholas Vanselow
Setting: Clinic
Interview suggested that Gail engaged in meltdowns and aggression….
when Mom was attending to other tasks or siblings….
in order to gain Mom’s undivided attention and to have Mom play with her and her most preferred toys.
Problem
Behavior
Context
(suspected establishing operations)
Outcome
(suspected reinforcers)
Suspected reinforcing contingency
So this the reinforcing contingency we suspect was influencing Gail’s problem behavior.

15. Functional Analysis: Test Condition
Test: Mom attends to other tasks and people….
As soon as Gail engaged in any problem behavior, Mom directs her undivided attention to Gail while interacting with her and her most preferred toys.
We then move on to the analysis to determine whether the hunch from the interview was valid.
In the test condition, we are emulating the conditions Mom described as being associated with Gail’s problem behavior. This condition started with Gail having her mother’s undivided attention and access to her most preferred toys. At the start of the session, Gail’s mother would remove the toys and attend to another person or task. If Gail engaged in any instance of problem behavior or its precursors such as whining, her mother would represent her undivided attention and preferred toys.

16. Functional Analysis: Test Condition
Test: Mom attends to other tasks and people….
As soon as Gail engaged in any problem behavior, Mom directs her undivided attention to Gail while interacting with her and her most preferred toys.
These are the data from the test sessions showing rates of problem behavior occurring.

17. Functional Analysis: Control Condition
Control: Mom directs her undivided attention to Gail while interacting with her and her most preferred toys the entire time.
In the control condition, we attempt to emulate the conditions Mom described as being associated with no problem behavior while also being sure to remove the contingency suspected of reinforcing problem behavior and, importantly, making no other changes to the condition.

18. Functional Analysis: Control Condition
Control: Mom directs her undivided attention to Gail while interacting with her and her most preferred toys the entire time.
We observed no problem behavior in control sessions.

19. Case Example: Gail, 3 years old, PDD-NOS
By alternating between 5 minute periods of test and control conditions, we were able to turn on and off Gail’s problem behavior….
Giving us and her Mom confidence as to why she was engaging in the extraordinary problem behavior
….to simply gain and maintain her Mom’s undivided attention and play time
By alternating between 5 minute periods of test and control conditions, we were able to turn on and off Gail’s problem behavior….
Giving us and her Mom confidence as to why she was engaging in the extraordinary problem behavior
….to simply gain and maintain her Mom’s undivided attention and play time

20. Case Example (Bob, 8 yo, dx: Autism) Therapist: Sandy Jin Setting: Clinic
Hypothesis: Bob engages in meltdowns and aggression in order to obtain: “His way” in the form of escape from adult instructions and access to preferred ways of interacting with electronics or academic materials
Onto a 2nd case. A 50-min interview with Bob’s parents showed that his problem behaviors of yelling, hitting, throwing or destroying property occurred whenever Bob did not get his way. Problems occurred more specifically when someone played the “wrong” apps or “wrong” way on an ipad or when someone did math incorrectly or corrected his way of doing math.
Our analyses showed this to indeed be the case. For instance, in the math context control condition, Bob was allowed to complete his math worksheets in any way he wanted, uninterrupted and never corrected. By contrast, prompts to do a particular math problem a particular way were provided in the test condition and if he had problem behavior he was allowed to do math his way for 30 s. We only saw problem behavior in these test sessions.
Is his problem behavior maintained by the negative reinforcement of terminating our prompting or by the positive reinforcement of access to his math workbook or iPad. Unlike the contingency influencing Gail’s problem behavior, the synthesized contingencies for Bob are difficult and probably meaningless to decouple, meaningless because the contingency analyzed was precisely the one described in his home and classroom, meaningless because we have enough information to develop a treatment, which is the primary reason why we functionally analyze.

21. Case Example (Dale, 11 yo, dx: Autism) Therapist: Sandy Jin Setting: Clinic
Hypothesis: Dale engages in meltdowns and aggression in order to obtain: “His way” in the form of escape from adult instructions and access to preferred (tangible) items, and adult attention.
The interview with dale’s parents told that he was very demanding, and when his requests were not honored, he would scream or become aggressive or destructive. In our test condition, we prompted Dale to complete typical homework and any problem behavior resulted in our terminating the prompts allowing him to walk away and watch a movie and we honored any of his requests during this “break” from homework. During the control condition he had access to “his way” the whole time (a permanent break with access to preferred items, and adult compliance with his mands). You can see that we were able to turn his problem behavior on and off in the analysis confirming the hunch about the function of his problem behavior from the interviews.

22. IISCA Interview Informed Synthesized Contingency Analysis
Open-ended interview to obtain qualitative, individual details
Combine EOs and reinforcers that are reported to co-occur
Functional control via multielement design

23. Some Important Aspects of our Approach
Extensive descriptive assessments are never part of the process
because they are:
time-consuming
and usually suggest invalid relations
St. Peter et al., 2005; Thompson & Iwata, 2007
Why are these analyses so fast, safe, and effective?
It is not because they were preceded by long periods of observation or informed by the correlations that result from those observations.
Pause

24. Some Important Aspects of our Approach
2. Closed-ended indirect assessments (MAS, QABF, FAST) are never used in the process
because they do not provide any information about personally unique or qualitative features of potentially influential variables
It is not because the analysis was preceded by a closed ended indirect assessment like the FAST or MAS or QABF. These were not conducted
because their results teach us nothing interesting, specific, or unique that we can then include in our analyses.

25. Some Important Aspects of our Approach
3. An open-ended interview is always part of the process (as is one brief and informal observation)
Goals of interview are to:
Develop rapport with parents or teachers
Identify unique contingencies
Develop “function hunches”
Set up a safe and quick analysis
Interviews allow for discoveries which can then be verified (or not) in a functional analysis
Our analyses are fast, safe, and effective for building treatments because they are informed by parents and teachers through our open ended interviewing. The interview we use is available in the review article I mentioned earlier and hard copies will be available here along with a summary of this presentation.
The take home point here, is interviews allow you to discover variables whose importance can be verified, or not, in a subsequent analysis.
Let parents tell you their story about problem behavior and listen for the EOs and reinforcers

26. Some Important Aspects of our Approach
4. A two-condition analysis designed from the open-ended interview is always part of the process (i.e., an interview-informed analysis)
Functional analysis:
Direct observation of behavior under at least two conditions in which some event is manipulated
Two Conditions:
Test: Contains the reinforcing contingency thought to maintain severe problem behavior
Control: Does not contain the reinforcing contingency thought to maintain severe problem behavior
Instead we commit to a 2 condition, test control analysis designed from our open-ended interview. These are still functional analyses in which the contingency thought to maintain severe problem behavior is programmed in the test condition and is removed from the control condition.

27. Some Important Aspects of our Approach
5. We synthesize multiple contingencies into one test condition, if the interview suggests the contingencies are operating simultaneously
And last, we synthesize multiple contingencies into one test condition, if the interview suggests the contingencies are operating simultaneously

28. Why might problem behavior occur?
Single contingencies:
Attention or toys (social-positive reinforcement)
Escape/avoidance (social-negative reinforcement)
Sensory/non-social (automatic reinforcement)
Combinatorial contingencies:
Attention and Toys
Escape to toys
Escape to toys and attention
Escape to automatic reinforcement
Compliance with mands
Escape to access to rituals, preferred conversations
Escape to controlling people or objects
Etc…..
In other words, instead of searching for the isolate effects of generic contingencies, we ask questions about contingency combinations that are alluded to or even explicitly described in our interviews.
Essentially we have moved towards replacing the “or” from above (is it maintained by escape, toys, or attention?) with an “and” (is it maintained by escape to toys and attention?).
Said another way: Instead of searching for the main effects of generic contingencies, we are searching for the effects of interactions among several specific contingencies. The premise here is that we are trying to emulate the ecology that is responsible for the maintenance of the problem behavior, and we think that ecology is more likely to be composed of interacting and unique contingences than isolated and generic ones.

29. Why synthesize? Seems to emulate the ecology better
Why synthesize contingencies in an analysis? It seems to run so counter to the point of an analysis.
The first reason we do it is because we seem to capture the natural ecology better with a synthesized contingency.
For example, there are very few situations in which children engage in problem behavior to terminate some ongoing mundane interaction such as academic instruction only to remain motionless and inactive, satisfied with the relief associated with that negative reinforcement. The children we serve, as well as most of us, escape not only from things but also to things. Both prepositions matter. When we isolate negative from positive reinforcement, we are probably creating test conditions that do not emulate the ecology from which problem behavior developed or is maintained (in other words we are analyzing contingencies that do not exist in nature). Because we are attempting to build treatments that will fit within the homes and schools in which problem behavior was presumably acquired and strengthened, we feel it is important to closely emulate that ecology in the functional analysis.

30. Why synthesize? Seems to emulate the ecology better
Isolated contingencies sometimes do not control behavior whereas synthesized contingencies do.
Call et al., 2005
Dolezal & Kurtz, 2010
Hanley et al., 2014
Ghaemmaghami et al., 2016
Mueller et al., 2005
Slaton et al., 2016
The second reason is that when contingencies are isolated, we sometimes do not see effects of those isolated contingencies, as I showed you above with Gail. But, we then see behavioral sensitivity to the contingencies when they are combined. Now we do not know the prevalence of control by synthesized contingencies, but we see this often now that we are looking, and others have seen it and reported it before us.
We often see that toys are more reinforcing when someone is available with whom to play and attention is more valuable when there is something with which to play. We often find that a break from instructions is more reinforcing when preferred items are available during the break and preferred items are more reinforcing when the alternative is work. In other words, isolated contingencies are often weak, too weak to evoke or stop problem behavior whereas synthesized contingencies are strong, capable of evoking and then deescalating behavior. In this process, strength matters, and synthesized contingencies are strong.

31. Here are a few more examples in which we relied on within-subject analyses of synthesized and isolated contingencies. For the bottom participant, Franklin, we see control by each contingency when separated as well as when they are synthesized in the IISCA.
By contrast, for Addison and Jay we see sensitivity to the synthesized contingency and no effect of the same contingencies when evaluated in isolation.
Here we see control by the whole contingency whereas we see no control by its constituent parts. Here we see that whole contingencies have properties not present in the parts and that sometimes whole contingencies are not reducible to the study of the parts.
Slaton et al., 2016

32. Why synthesize? Seems to emulate the ecology better
Isolated contingencies sometimes do not control behavior whereas synthesized contingencies do
Let me try this analogy:
How many of you eat flour, find baking flour reinforcing on its own. How about cinnamon on its own. How many of you eat a stick of butter for breakfast or just a raw egg. By contrast, how many of you, like me love a piece of cinnamon coffee cake. I will work for coffee cake, but I do not found the cake’s components reinforcing on their own.
**If you can be fast, safe, and effective with the coffee cake for your clients, why not just work with the coffee cake? Why spend the resources deconstructing the cake when it exists as a whole in their world. Why spend the resources deconstructing the cake only to find that when you do, you have taken something that was valuable, and now made it tasteless. These are the main reasons we synthesize contingencies in our analyses.

33. Why synthesize? Seems to emulate the ecology better
Isolated contingencies sometimes do not control behavior whereas synthesized contingencies do
Doing so leads to effective action—
Fast, safe, and clear analyses
Meaningful treatment effects
Hanley et al., 2014, Santiago et al., 2016; Ghaemmaghami et al., 2016
But perhaps the most important reason for considering synthesized contingencies is that their adoption in analyses has allowed for fast and strong control of problem behavior in analyses and the development of function-based treatments capable of meaningful (socially validated) behavior change. I will now expand on these points.

34. They include children and adults With and without autism
From Jessel, Hanley, and Ghaemmaghami (in press)
Here are the results of 16 interview-informed synthesized contingency analyses
They include children and adults
With and without autism
They were conducted in our clinic, or in others classroom, vocational sites, or homes
And they were implemented by people with much or very little experience with functional assessment
Note the smaller number of sessions required.
Note the smaller amount of variability, especially in the control condition sessions.
We have since consulted with over 15 service centers in multiple countries and have witnessed effective analytic outcomes in over 100 applications.

35. From Rajaraman et al. (2016)
Problem behavior per minute
Dithu Rajaraman just concluded a follow up in which he described 50 more replications across different problem behavior types and contexts. Yes, the IISCA has generality.
Sessions

36. Take Home Point
Prior to treating problem behavior of children with autism
Conduct an open ended interview to discover the context and outcomes that seem relevant to problem behavior
Conduct an IISCA to demonstrate the validity of the suspected contingency
and to have access to the properly motivating conditions to teach skills
Trust but verify. This proverb does not reveal anything about my political leanings but it does capture my commitments as a behavior analytic practitioner.
I am asking you to trust yourself and the parents and teachers you interview. Trust the interview process.
I am then asking you to verify that information scientifically. Be a behavior analyst. Only then, only after the process of trusting and verifying, should you have the confidence to move towards treatment.

37. Good luck with all that you do for all who you teach and provide care
For more information go to:
Contact info.:
Gregory P. Hanley, Ph.D., BCBA-D
Psychology Department
Western New England University
1215 Wilbraham Road
Springfield, Massachusetts 01119
Thank you very much.
Most of these changes to #/length of sessions, measures, etc. are like putting racing stripes on a big old Cadillac, that Cadillac will move but it is still going to guzzle up your time, the brakes don’t work so well and it never had seat belts to begin with, so you may lose control and it may get dangerous, but ultimately the problem is that, more times than not, that old Cadillac is not going to get you where you want to go.