A Focus on a Safer, Faster, and Still Effective Process

A Focus on a Safer, Faster, and Still Effective Process
Functional Assessment of Severe Problem Behavior of Persons with Autism: A Focus on a Safer, Faster, and Still Effective Process Gregory P. Hanley. Ph.D., BCBA-D For more information go to: Central Michigan University & Central Autism Assessment and Treatment Center August, 2016

is attainable from these behaviors
freedom from these behaviors for persons with Autism and their caregivers is attainable Lasting freedom from meltdowns, aggression, and self-injury for persons with Autism and their families is attainable. It is attainable in the large majority of cases without drugs, hospitalization, harsh punishment, and even without candies, stickers, and token boards. This freedom is attainable by first understanding why the child is engaging in the severe problem behavior and then incorporating that understanding into the teaching of transferable skills like communication, toleration, and compliance with reasonable instructions. And contrary to conventional professional wisdom, this understanding as to why problem behavior occurs can be realized quickly, safely, and reliably and is essential for helping families of children with autism avoid a lifestyle dictated by problem behavior.

Fact: Autism is characterized by
Impairments in language development social interaction and Excessive repetitive behavior Because we often serve persons diagnosed with autism, let’s start there. The latest estimate from the CDC is that about 1 in 50 children have been identified as having an Autism spectrum disorder in the US. There is no biological determination of autism; however, the behavioral symptoms are typically apparent before 3 years of age. Autism is characterized by impairments in social interaction and communication and by restricted, repetitive, or stereotyped patterns of behavior.

But what is the most difficult issue for parents and teachers of most children and young adults with autism? It is pb and it not the autism that leads to restrictive lifestyles of families of children with autism, it is not the autism that negatively affects the mental health of parents of children with autism—it is the chronic problem behavior, that affects more families of children with autism than not.

With Autism, there is a higher likelihood of problem behavior
Fact: With Autism, there is a higher likelihood of problem behavior Meltdowns Aggression Self-injury References: Baghdadli, Pascal, Grisi, & Aussilloux, 2003; Horner et al., 2002; Kim et al., 2000; Murphy, Healy, & Leader, 2009; Thompson, 2009 Although a diagnosis of autism is not dependent on problem behaviors like aggression, self-injury,or meltdowns--those highly emotional outbursts and tantrums of extended duration that are clearly disproportionate to the circumstances, the probability of one or more of these problem behaviors occurring with regularity is higher in children with autism than in children with other developmental disabilities. For instance, researchers have reported a 10 to 15% prevalence rate of these problem behaviors in persons with an intellectual disability, By contrast, it is estimated that 50% of children with autism engage in self-injurious behavior; and that 2/3rds engage in at least one of the problem behaviors with regularity.

Problem behavior has led to a highly restrictive life style
Fact: Problem behavior has led to a highly restrictive life style for many persons with autism and their families What these prevalence studies indicate, and what experience has revealed, is that problem behavior has become a life style for many persons with autism and their families. Many children who were aggressive or injurious at 6 years of age are still aggressive or injurious as teenagers. Many parents I meet in our clinic or during consulting believe very strongly that severe problem behavior is inevitable for their child “because of the autism.” And as the problem behavior persists over time, a highly restrictive life style characterized by few feelings of freedom and little joy has become commonplace for parents, the child with autism, and their siblings. Problem behavior is the strongest predictor of psychological well being of parents of children with autism and the relationship is an inverse one.

Why do “lifestyles” dictated by problem behavior persist for families of children with autism?

Why do “lifestyles” dictated by problem behavior persist for families of children with autism? Opinion: This lifestyle persists partly because problem behavior of children with autism is merely modified, medicated, or mollified

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. The main assumption here is that if a problem behavior is occurring with regularity, that the behavior is being reinforced. A simple but powerful assumption. Our main job with the functional assessment is to find that reinforcer or, more likely, those reinforcers and the contexts that seem to potentiate those reinforcers. behavior analysts conduct functional assessments

Functional Assessment Process
Indirect Assessment interviews Descriptive Assessment observations The functional assessment process has evolved to include some combination of indirect assessment, descriptive assessment, and functional analysis. Indirect assessments are the initial interviews with caregivers or teachers. Descriptive assessment involves observation and measurement of the problem behavior and its context; by contrast, functional analysis consists of observation and measurement of the problem behavior in at least two conditions, with the variables suspected of influencing problem behavior conspicuously present in one and absent in the other. Functional Analysis observations with manipulation

Why should BCBAs conduct functional analyses prior to treating severe problem behavior?

Fact: Functional analysis of problem behavior is well researched
435 studies with functional analyses and 981 distinct functional analyses have been published between 1961 and 2012 Beavers, Iwata, & Lerman, 2013; Hanley, Iwata, & McCord, 2001 Functional analysis of problem behavior is well researched. Functional analysis is that part of the functional assessment process by which behavior analysts observe behavior while manipulating some aspect of the environment thought to be responsible for that behavior in order to determine the practical factors responsible for the problem behavior. And the analysis is integral to the success 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.

Fact: Functional analysis is integral to the success 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, Heyvaert, Maes, Van den Noortgate, Kuppens, Onghena, 2012 Functional analysis of problem behavior is well researched. Functional analysis is that part of the functional assessment process by which behavior analysts observe behavior while manipulating some aspect of the environment thought to be responsible for that behavior in order to determine the practical factors responsible for the problem behavior. And the analysis is integral to the success 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.

Opinion: Functional analysis is humane and dignifying
Functional analysis of problem behavior is well researched. Functional analysis is that part of the functional assessment process by which behavior analysts observe behavior while manipulating some aspect of the environment thought to be responsible for that behavior in order to determine the practical factors responsible for the problem behavior. And the analysis is integral to the success 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.

Many (most?) Behavior Analytic Practitioners
who work with children with autism and/or intellectual disabilities have shied away from conducting functional analyses (Desrochers, Hile, & Williams-Mosely, 1997; Ellingson, Miltenberger, & Long, 1999; O’Neill & Johnson, 2000; Weber, Killu, Derby, & Barretto, 2005) Why? But surveys often show that many, even behavior analytic, practitioners who work with children with autism or intellectual disabilities do not routinely conduct functional analyses and instead rely on closed-ended interviews such as the MAS, QABF, or FAST, or on descriptive assessment, in which one watches the child behave while measuring antecedents to and consequences for the problem behavior. It is understandable why other helping professionals do not conduct functional analyses, but it is more troubling that behavior analytic practitioners are not routinely conducting analyses when confronted with severe problem behavior. Why don’t behavior analytic practitioners conduct functional analyses prior to treating severe problem behavior?

Why? Took too much time and resources,
Never did one before (i.e., training issue), Seemed unsafe, Were unsafe, Often inconclusive Still ended up using behavior modification-based treatment i.e., arbitrary rewards in DROs & punishment See Oliver, Pratt, & Normand (JABA, 2016) There are no firm answers, but here are some that have been written about or frequently offered up by behavior analytic practitioners: Some say that they did it before, but it took too much time and resources. By contrast, some offer that they have never done one and do not feel comfortable doing one because they were never trained on how to do one. Some go further and opine that the analysis seems dangerous for both they and their clients Others base this concern with safety on direct experience with a functional analysis that was indeed dangerous. Other have found that they were unable to obtain differentiated results. Even when differentiated results are produced, some offered that when all was said and done, they ended up implementing a treatment that was very similar to the one they would have implemented had they not conducted an analysis

Summary of procedures for overcoming obstacles to being analytic published in 2012:
For a copy, just Google: functional assessment myths (article also contains our open-ended interview) Folks: The functional analysis literature is overflowing with solutions to many of these common obstacles. Granted, they are hard to access, because they are distributed across a large and complicated literature. I summarized some of the solutions in this review in the context of some of my own procedural commitments when it comes to conducting functional analyses. Please take a look at this article if you are a behavior analyst struggling with the idea of conducting functional analyses…. But, just after writing this article, my research and practice group started committing to a slightly different approach and this approach was allowing us to be very effective in our clinic and in our consults because this approach was faster, safer, and led to more effective treatments than anything I had done in the past. I will focus on this relatively new approach today. This approach is illustrated in:

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

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 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. The interview suggested that Gail engaged in meltdowns and aggression in order to obtain preferred items (usually toys) and maternal attention. This is where I like to point out that extraordinary behavior is usually influenced by very ordinary events and interactions. Our analysis then involved two conditions—the test, in which we try to emulate the conditions under which the problem has been reported to occur and the control, in which the factors thought to be responsible for problem behavior are removed. We alternate between 5 min test and control sessions in small observations rooms in our outpatient clinic at the university.

Case Example (Gail, 3 yo, dx: PDD-NOS) Therapist: Nicholas Vanselow Setting: Clinic
Hypotheses: Gail engages in meltdowns and aggression in order to obtain: preferred (tangible) items, And maternal attention, We went on to show that Gail’s problem behavior was sensitive to both tangible items and attention when combined as reinforcement and only when provided by her mother. In other words, the more traditional tests of the isolated contingencies of attention or tangible items yielded undifferentiated analyses. Only when both the tangible and attention contingencies were synthesized into one test condition did we see differentiation in our analysis.

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.

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, adult interaction). 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. These analyses were the first of three done in our clinic.

Discuss with your neighbor.
Take a moment to reflect on this particular functional assessment process. How is it similar to and different than the process you implement? Discuss with your neighbor. Before I try to answer any questions, let me reflect on the process. Before I summarize what the process should look like, let’s hit another mistake of mine. I used to think that all functional analyses required 5 or more conditions, but that is not the case. The defining features of a functional analysis are **direct observation of behavior under at least two conditions in which some event is manipulated The two conditions** can be thought of as test and control conditions where there is one fundamental difference between the two: the Test conditions contains the contingency thought to maintain severe problem behavior, whereas the Control condition does not. You don’t need 5 or more conditions. A good front end interview and brief observation should lead you to a hunch that you can test out with only two conditions. Here is an example.

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

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.

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

4. A standard 4 or 5 condition analysis (with the play condition as the control, e.g., Iwata et al., 1982) is never part of the process Probably a mistake to standardize a powerful and flexible tool like a functional analysis It is probably evident at this point that a standard multielement analysis is never part of our assessment process. We think that is a mistake to standardize a powerful and flexible tool like a functional analysis, but we also think that when behavior analysts commit to a standard analysis, that I will define in a moment, they are committing to long, possibly unsafe process that often yields undifferentiated results.

5. 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.

6. 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

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.

Some standard analyses published a while ago
Here are some analyses I had the opportunity to conduct and publish in the 90s while at the Kennedy Krieger institute. Note how many sessions were required Note the variability in the data

Even when differentiated, note the variability, especially in the control condition, and again how many sessions were required.

Here as well

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.

Consider an Interview Informed Synthesized Contingency Analysis
IISCA? Interview-informed Synthesized Contingency Analysis Single-test condition Individualized test conditions Synthesized contingencies Test-specific control Reinforce precursors to and dangerous behavior Standard Functional Analysis Multiple test conditions Uniform test conditions Isolated test contingencies Toy-play control conditions Reinforce dangerous behavior So, I am suggesting that….rather than conduct a standard functional analysis, that you consider an interview-informed synthesized contingency analysis: here are its hallmarks: ; When you do an analysis, please reinforce precursors to and dangerous behavior This too is not an “or” situation. If you go into the analysis with the plan to only reinforce dangerous behavior, eventually you will be experiencing a lot of dangerous behavior. If you go into the analysis with the plan to only reinforce precursors, and dangerous behavior occurs and you don’t reinforce it, the dangerous behavior will likely escalate. If you go into the analysis with the plan to provide the suspected reinforcers for both precursors and dangerous behavior, you will turn off dangerous behavior and eventually be experiencing precursor behavior.

Towards a more efficient analysis
He found that standard analyses as I previously defined and which are more common nowadays than ever before in our published literature, take an average of 5.5 hours, meaning half have taken longer than that. IISCAs have thus far required an average of 22 minutes to conduct.

Levels of Analytic Control
Strong Test condition: Consistently elevated rates Control condition: Zero or near-zero rates Moderate Test condition: Some zeros or near-zero rates Weak Test Condition: Variable but higher rates Control condition: Lower but non-zero rates Analytic or experimental control of behavior is often considered a binary dimension; In other words you either have demonstrated experimental control or you have not. But most visual inspectors of data come to understand that there are also varying degrees of experimental control and these varying degrees can be measured and it is important to consider them because of the implications of exerting strong or weak control in functional analyses. So while reviewing the same functional analysis literature, Josh also scored analyses based on how much control was exerted over the problem behavior in each type of analysis. Here are the definitions with representative analyses:

Towards a more controlled analysis
And here is the percentage of applications of the different functional analysis formats that exerted strong, moderate, weak or experimental control of behavior. Control is often not demonstrated in what is usually termed brief analyses or in trial based analyses. The more important finding however is that the standard analysis yields weak control of problem behavior in just over half of the analyses. By contrast, strong control over problem behavior is demonstrated in 88% of the interview-informed synthesized contingency analyses. You might be thinking-- who cares --a differentiated analysis is good enough, is it not?

Interpretation and Implications of Varying Levels of Analytic Control
Strong experimental control Interpretation: Have access to all reinforcers and EOs Implication: Can turn off problem behavior with reinforcement; should achieve meaningful outcome with only function-based treatment Here is why I think it matters: When you have strong experimental control in a functional analysis you presumably have access to all reinforcers and EOs relevant to problem behavior, at least in the analytic setting. The implication is that because you were able to turn off problem behavior with reinforcement in the analysis, you should be able to achieve meaningful outcomes with only function-based treatment.

Moderate experimental control Interpretation: Some other EO is probably uncontrolled and interacting Implication: Skill development may be slower as motivation may vary across sessions, but should achieve meaningful outcome with only function-based treatment When you have moderate experimental control, it seems that some other EO is probably unaccounted for and is probably interacting with the programmed contingency. The implication of this type of control is that skill development may be slower as motivation may vary across upcoming treatment sessions, but you should still should achieve a meaningful outcome with only function-based treatment, again the process just might be a little slower than if you had stronger control of behavior.

Weak experimental control Interpretation: All reinforcers for problem behavior are not identified Implication: Variable responding will persist throughout skill development, probably necessitating punishment or arbitrary reward system The necessity of punishment when function-based treatments are made more practical is commonly reported: Fisher et al., 2003, Hagopian et al.,1998, Hanley et al., 2005, Wacker et al., 1990 When you have weak experimental control, which is most likely the result of a standard analysis, it is apparent that all of the reinforcers have not been identified. The implication of this type of analytic control is that variable levels of problem behavior will probably persist while functional replacement skills are being developed thus necessitating at one point or another some sort of punishment or arbitrary reward system. The necessity of punishment to maintain near zero rates of problem behavior when function-based treatments are made more practical is no secret. Folks: We have been frequently basing treatments off of these types of functional analysis baselines since the advent of functional analysis. Despite the significant presence of functional analyses of problem behavior in our research literature for over 30 years, people with intellectual disabilities or autism who engage in severe problem behavior are still being treated with punishment and arbitrary reinforcement within token programs. I think it is because we are treating off these baselines in which problem behavior is weakly controlled----- why is it weakly controlled, because historically we have not accounted for all of the personally relevant reinforcers for problem behavior when we design our treatments. When all reinforcers are not managed, in other words provided differentially, the establishing operation for one or more reinforcers is present and evokes problem behavior even while our function-based treatment is implemented with integrity.

To achieve the humane outcomes that are possible with exclusive reliance on function-based treatments, it is important that we do everything we can to exert strong experimental control in our analyses. The point here is that in order to achieve the humane outcomes that are possible with exclusive reliance on function-based treatments, it is important that we do everything we can to exert strong experimental control in our analyses. Interview informed synthesized contingency analyses yield strong experimental control in most applications.

Slaton, J., Hanley, G., & Raftery, K. (under review, JABA)
As I mentioned, there were 9 participants in Study 1. They were all children with autism who attended a private day school; here’s a table summarizing basic information about them. You can see there were seven boys and two girls, and they ranged in age from 7 to 18. And you can see that there was a range of language abilities; some communicated vocally and some communicated using speech-generating devices. And lastly you can see that they were referred by their clinical teams for a variety of different problem behaviors.

IISCA vs. Standard Analysis
Here’s the first pattern: problem behavior occurred during the IISCA, and did not occur at all during the standard analysis. This was the case with three participants: Diego, Mason, and Riley. We have the IISCA for each participant shown in the left panel, and the standard analysis shown in the middle panel, with sessions depicted along the x-axis and problem behavior per min depicted on the y-axis. In Diego’s case, we also replicated his IISCA to verify that the functional relation was still operating, and that’s presented in the far right panel. Test conditions are indicated by closed symbols; the control condition is indicated by an open circle. And the particular contingency evaluated in each IISCA test condition is noted in italics. So you can see that Diego and Mason’s IISCAs both indicated a functional relation between problem behavior and escape to tangibles and attention; Riley’s IISCA indicated a functional relation between problem behavior and escape to tangibles. You can also see that the standard analyses were undifferentiated for these 3 participants because no problem behavior occurred.

Here’s the second pattern we observed: problem behavior occurred during both analyses, but in the standard analysis was not elevated in any particular test condition relative to the play condition. You can see this was the case with Kyle and Jonah. Kyle’s IISCA indicated a functional relation between problem behavior and escape to a preferred, predictable schedule; Jonah’s IISCA showed a functional relation between problem behavior and escape to attention, tangibles, and stereotypy. However, for both of these participants, the standard analysis was undifferentiated because problem behavior persisted across all conditions or occurred in multiple conditions.

The third pattern we observed was that both analyses were differentiated. This was the case for our remaining four participants. Dylan’s IISCA detected a functional relation between problem behavior and escape to tangible items; his standard analysis was differentiated for escape and tangible items separately. For Emily and Chloe, the synthesized contingencies in their IISCAs involved escape to other items; their standard analyses were differentiated for escape only. And last, for Jeff, his standard analysis detected a reinforcer that was not part of his synthesized contingency at all. His IISCA indicated a functional relation between problem behavior and escape to tangible items; his standard analysis indicated an attention function. We interpreted his standard analysis this way because the attention condition was the only condition that was consistently elevated relative to the play condition.

Here’s a table showing the specific functional relations detected by each analysis for each participant.

Why was the IISCA differentiated more often than the standard analysis?
Maintenance by interactions may be more prevalent than we realize Detecting interactions Is an advantage of the IISCA There are several reasons why the IISCA may have been differentiated more often than the standard analysis. Returning to Figure 1, the data for these participants suggest that problem behavior was maintained by the interaction between contingencies, rather than the individual effects of any particular contingency. Perhaps interactions between contingences are more prevalent than we realize. We think these data suggest maintenance by interactions because problem behavior was only evoked when we interrupted access to tangibles AND presented demands. None of the isolated conditions in the standard analysis evoked problem behavior. In the standard analysis when we interrupted access to tangibles but did not present any demands, no problem behavior occurred. When we presented demands but there were no tangibles that we had to remove in order to present those demands, no problem behavior occurred. So one potential advantage of the IISCA may be its ability to detect interactions. (Talk also about precursors and synthesizing response classes)

Why was the IISCA differentiated more often than the standard analysis?
Standard analysis did not capture all relevant reinforcers The data from figure 2 also suggest that perhaps problem behavior was sensitive only to a combination of reinforcers. Problem behavior did occur in the standard analysis, but the fact that it occurred inconsistently suggests there may have been relevant variables missing from these isolated conditions. When problem behavior persists across multiple conditions, it is often interpreted as automatically maintained. But in this case, the fact that the IISCA was differentiated for both participants indicates that there IS an arrangement of socially-mediated variables capable of reliably evoking and suppressing problem behavior.

Treatment Comparison Results
Here are Emily and Jeff’s data. We have data from IISCA-based FCT in the left panel, and data from standard-based FCT in the right panel. The closed symbols indicate problem behavior, and the open symbols indicate independent FCR. The baseline data are the data from the functional analyses conducted in study 1. For both of these participants, you can see that problem behavior was quickly eliminated during IISCA-based FCT, and independent use of the FCR was acquired within 2 sessions for Emily and 5 sessions for Jeff. By contrast, problem behavior persisted during standard-based FCT for both of these participants, and independent use of the FCR was never acquired.

Treatment Comparison Results
Here are Chloe and Dylan’s data. You can see that problem behavior for Chloe initially persisted in both conditions, but was then eliminated by the 8th session of each condition, and she easily acquired both FCRs. For Dylan, problem behavior was immediately eliminated in all conditions, and all 3 FCRs were quickly acquired.

Consider an Interview Informed Synthesized Contingency Analysis
IISCA Interview-informed Synthesized Contingency Analysis Single-test condition Individualized test conditions Synthesized contingencies Test-matched control Reinforce precursors to and dangerous behavior Standard Functional Analysis Multiple test conditions Uniform test conditions Isolated test contingencies Toy-play control conditions Reinforce dangerous behavior So, I am suggesting that….rather than avoid analyses altogether and rather than conduct a standard functional analysis (the key components are noted here), that you consider an interview-informed synthesized contingency analysis: here are its hallmarks: A single, individualized, test condition that synthesizes all suspected contingencies, the programming of the contingencies not just for dangerous behavior but for all problem behavior that is reported to co-occur, and the inclusion of a matched control in which all suspected reinforcers are provided continuously but nothing else is changed.

But is it valid? Be wary of the unanswerable:
“Is that the true function?” Remember our Truth Criterion: Effective Action Applied to Functional Analysis: That which is valid is that which leads to the most general and socially validated change in problem behavior No analysis vs. analysis comparison can demonstrate validity.

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.

Why is it important to conduct a functional assessment with a functional analysis as part of the process prior to treating severe problem behavior? because the functional assessment process is humane and dignifying because behavior modification is ineffective because research reviews show that more effective treatments result from functional assessment processes, especially those that contain a functional analysis

Identify the functional assessment tools that can be omitted from an effective functional assessment process of severe problem behavior. closed ended indirect assessment and functional analysis open-ended indirect assessment and formal descriptive assessment closed-ended indirect assessments and formal descriptive assessments open-ended indirect assessment and functional analysis

What are the essential components of a functional analysis of problem behavior?
direct observation of problem behavior during least 4 rapidly alternating conditions (demand, attention, alone, and toy play) direct observation of problem behavior in a condition containing the reinforcing contingency thought to maintain severe problem behavior and one condition in which this contingency is absent indirect observation of problem behavior during several test conditions and a toy play control condition direct observation of problem behavior in the natural environment

Nominate the essential features of an interview informed synthesized contingency analysis (IISCA)
Test-matched control condition Interview-informed synthesized contingency Single and individualized test condition Reinforcement programmed for precursors to and dangerous behavior

What does an informed analysis provide the behavior analytic practitioner?

What does an informed analysis provide the behavior analytic practitioner?
a demonstration of problem behavior sensitivity to a suspected reinforcement contingency the truth regarding the variables controlling problem behavior a stable and sensitive baseline from which to evaluate treatment a properly motivating set of conditions to teach functional communication and delay tolerance

Come up with at least one question relevant to conducting the functional assessment process.
Before I summarize what the process should look like, let’s hit another mistake of mine. I used to think that all functional analyses required 5 or more conditions, but that is not the case. The defining features of a functional analysis are **direct observation of behavior under at least two conditions in which some event is manipulated The two conditions** can be thought of as test and control conditions where there is one fundamental difference between the two: the Test conditions contains the contingency thought to maintain severe problem behavior, whereas the Control condition does not. You don’t need 5 or more conditions. A good front end interview and brief observation should lead you to a hunch that you can test out with only two conditions. Here is an example.

Let’s role play some functional analyses.
Hand-to head-SIB and groaning appear to be maintained by: Tangibles Escape from demands to access tangibles Escape from demands to access tangibles, attention, and stereotypy Compliance with the child’s mands (Escape from the teacher’s way to access the child’s way) We are gathered at this conference to better understand Autism so lets start here. The latest estimate from the CDC is that about 1 in 50 children have been identified as having an Autism spectrum disorder in the US. There is no biological determination of autism; however, the behavioral symptoms are typically apparent before 3 years of age. Autism is characterized by impairments in social interaction and communication and by restricted, repetitive, or stereotyped patterns of behavior.

Let’s design analyses from interview results.
Some tips: Do not put responses in contingency class that are likely to be maintained by automatic sr. Do consider putting mands (e.g., protests) in the contingency class if severity of pb is outrageous. Incorporate the most challenging and convenient EOs. Use challenging and inconvenient EOs as tests of treatment generality Conduct analysis where you have the most control and will be able teach the skills. Err on the side of synthesizing too many contingencies rather than too few. We are gathered at this conference to better understand Autism so lets start here. The latest estimate from the CDC is that about 1 in 50 children have been identified as having an Autism spectrum disorder in the US. There is no biological determination of autism; however, the behavioral symptoms are typically apparent before 3 years of age. Autism is characterized by impairments in social interaction and communication and by restricted, repetitive, or stereotyped patterns of behavior.

We are gathered at this conference to better understand Autism so lets start here.
The latest estimate from the CDC is that about 1 in 50 children have been identified as having an Autism spectrum disorder in the US. There is no biological determination of autism; however, the behavioral symptoms are typically apparent before 3 years of age. Autism is characterized by impairments in social interaction and communication and by restricted, repetitive, or stereotyped patterns of behavior.

Get together with team members and design an analysis based on contingency suspected of influencing problem behavior Share with group next to you. Before I summarize what the process should look like, let’s hit another mistake of mine. I used to think that all functional analyses required 5 or more conditions, but that is not the case. The defining features of a functional analysis are **direct observation of behavior under at least two conditions in which some event is manipulated The two conditions** can be thought of as test and control conditions where there is one fundamental difference between the two: the Test conditions contains the contingency thought to maintain severe problem behavior, whereas the Control condition does not. You don’t need 5 or more conditions. A good front end interview and brief observation should lead you to a hunch that you can test out with only two conditions. Here is an example.

Treating Severe Problem Behavior: A Focus on Strengthening
Socially Important Behavior of Persons with Autism Gregory P. Hanley. Ph.D., BCBA-D For more information go to: Please use the workbook for taking notes. Write down questions. There are two times scheduled for Q&A. Let me be frank. I hope to convince you today that despite the buffets of functional assessment options and the larger buffet of treatment options that…. its not all good. That there are better, faster, and safer ways to conduct assessments and that some treatments are geared better than others for yielding socially meaningful outcomes. I have been conducting functional assessments and function-based treatments for 25 years. I only started being comfortable and confident in the process over the last 4 or so years. Central Michigan University & Central Autism Assessment and Treatment Center August, 2016

IISCA-Based Treatment
Process has led to comprehensive treatments with large effects Treatment relies on strengthening: functional communication delay/denial toleration compliance The study I mentioned earlier shows that this process of interview and analysis leads to comprehensive treatments with large effects. The treatment relies on strengthening: functional communication delay/denial toleration compliance

Functional Assessment and Treatment Model
Steps (expanded) 1 Interview 2 Functional Analysis 3 Simple Functional Communication Training 4 Complex FCT 5 Tolerance Response Training 6 Easy Response Chaining 7 Difficult Response Chaining 8 Treatment Extension So at this point, we have come to some understanding as to why problem behavior occurs and have taught a replacement behavior but we are far from being done because this is not a treatment that can be handed off to parents at this point. The real challenging part of the process is that which follows. Due to time constraints, I will describe it in detail only for Dale.

Treatment Analysis Dale 11-year old boy diagnosed with Autism
We then taught Dale an explicit response to the delay and denials and that was to “take a deep breath and say Okay while looking at the adult”. Once he engaged in the tolerance response, we allowed him “his way time”. (Just say okay and you can have it your way) You can see problem behavior returning to near zero levels as he starts engaging in this tolerance response. I want to point out that while we are teaching these skills, we are careful about evaluating the effects of treatment within single subject experimental designs. For instance, we have shown functional control of problem behavior within a reversal design here. We have shown functional control over the skill acquisition in a multiple baseline design by showing that the social skills occur when and only when a reinforcement contingency is arranged. We employ single subject experimental designs to make sure that the behavioral improvements are indeed a function of what we are doing and will be recommending to parents when our consultation is over.

PROGRESSIVE INCREASE IN COMPLEXITY OF INSTRUCTIONS 1 Simple motor movements Walk over here, stand up, sit down, clap your hands, touch your (shoulder, head, toes) 2 Simple academics Draw a circle, write your name, copy what I write Homework/Task preparation Unzip your backpack, take out the book, erase the board come to the board, put these books on the book shelf 3 Complex academic: Reading skills Read this paragraph, Answer this question…., Sound out the words Complex academic: Math skills Solve this (addition, subtraction etc…) Self-help skills Wash your hands, do this chore (e.g., organizing chairs) Play skills Throw or kick the ball Our next step was to initiate the response chaining portion of his intervention where we gradually increase the complexity of the instructions issued to him and the amount of time before the denied reinforcer is provided for his communication. As you can see the percentage of time in reinforcement gradually decreases, the complexity of the instructions increases until we are issuing instructions that are age-appropriate and of the ilk his parents reported as most troublesome. The thicker bars here show that he is complying with the instructions the great majority of the time.

At this point we extend the treatment to parents and to different contexts including the home. Yes, we still make house calls. During this transition, his repertoire is right where we would like it to be.

And the reinforcement level is low and his compliance with developmentally appropriate instructions is high. Here I have noted some of the gradual steps we took in transitioning the treatment to the parents and into the home. Talk about wish list (retaliation list) and outcomes for Gail and Bob MANNER IN WHICH TREATMENT WAS EXTENDED TO FAMILY AND HOME Three analysts alternated while parents observed the sessions Following training, the father was introduced after the analyst presented the evocative trial and halfway through the session; the mother was present in the session room The mother implemented treatment in the session room Parents varied the type and amount of instructions during the delay period Parents implemented treatment in the home while novel instructions were introduced

Discuss with your neighbor.
Take a moment to reflect on this particular treatment process. How is it similar to and different than the treatment you implement? Discuss with your neighbor. Before I summarize what the process should look like, let’s hit another mistake of mine. I used to think that all functional analyses required 5 or more conditions, but that is not the case. The defining features of a functional analysis are **direct observation of behavior under at least two conditions in which some event is manipulated The two conditions** can be thought of as test and control conditions where there is one fundamental difference between the two: the Test conditions contains the contingency thought to maintain severe problem behavior, whereas the Control condition does not. You don’t need 5 or more conditions. A good front end interview and brief observation should lead you to a hunch that you can test out with only two conditions. Here is an example.

Treatment Results from Hanley et al., JABA, 2014 Similar results were obtained with all three children Similar results were replicated in home and schools settings (Santiago, Hanley, Moore, & Jin, under review, JADD) All this talk of speed and analytic control is unimportant relative to the extent to which this approach leads to effective treatment outcomes. Again the bottom line is whether an approach allows for more effective action and this approach has allowed us to develop integrated and comprehensive treatments that produce large effects. In baseline, the data shown in black, there was problem behavior and little to no functional communication, tolerance, or compliance for the participants in our recent JABA study, but these skills were well developed at the end of treatment and the baselines from the interview informed synthesized contingency analyses provided the properly motivating conditions for these skills to be developed.

Time Assessment Taking into account the going rates of the behavior analysts working together during this process, the projected cost for these outcomes is between 6 and 9000 us dollars. Considering the much higher costs of inpatient psychological services (which is about $8000 per day), out-of-district educational placements (which cost between 80 and 130,000 per year), or long-term supported care for individuals with autism, which was estimated to be 3.2 million dollars across their lifetime, proper assessment and treatment of these problem behaviors while children with autism are young seems a reasonable investment. This process costs about the same as a family of 4 week long vacation in Disneyworld, about the same as smoking 2 packs a day in Massachusetts, or about the same as getting the navigation, moon roof package, and wood paneling package in an SUV.

Cost Assessment Taking into account the going rates of the behavior analysts working together during this process, the projected cost for these outcomes is between 6 and 9000 us dollars. Considering the much higher costs of inpatient psychological services (which is about $8000 per day), out-of-district educational placements (which cost between 80 and 130,000 per year), or long-term supported care for individuals with autism, which was estimated to be 3.2 million dollars across their lifetime, proper assessment and treatment of these problem behaviors while children with autism are young seems a reasonable investment. This process costs about the same as a family of 4 week long vacation in Disneyworld, about the same as smoking 2 packs a day in Massachusetts, or about the same as getting the navigation, moon roof package, and wood paneling package in an SUV.

IISCAs have led socially-validated outcomes
The procedures, treatments, amount of behavior change, and overall consultation process were also socially validated by the families of the children participating in the process. I never asked these questions when doing standard analyses and basing treatments off of the standard analyses because I knew the unfortunate truth, that despite measurable improvements, the amount of behavior change and resulting treatments were often not satisfactory. from Hanley et al., 2014

Personalized Social validity Data
When asked about their comfort level with presenting the specific situations that were initially reported to evoke problem behavior, ratings improved for all parents between the initial and their last meeting with the behavior analyst and the parents reported being very comfortable with presenting evocative situations after being trained on the treatment.

Some open-ended responses from the Social Acceptability Questionnaire

These are two of the more legible responses to open-ended questions.

Ten Unique Aspects of our Approach (continued)
7. Our function-based treatments are always skill-based NO EXT only, DRO, or NCR Published in Behavior Analysis in Practice in 2008 (available for free at PubMed Central)

Ten Unique Aspects of our Approach
8. We always increase the complexity, flexibility, and/or interactional nature of the FCR before teaching delay/denial tolerance Simple FCR: (“My way” or “My way, please”) Complex FCR: “Excuse me” After a second or two, “Yes, Billy” “May I have my way, please?” “Will you play my way, please?” After a second or two, “Sure, Billy” Don’t need extinction here, could provide more immediate, longer, and higher quality reinforcers for complex FCR and delayed shorter and lower quality functional reinforcers for the simple FCR.

Prompting: Immediate then faded.
NO EXT only, DRO, or NCR Prompting: Immediate then faded.

Shape the complex response
We have a very specific and emprically validated approach to teaching kids to handle disappointment. I am sorry I cannot review each of these in detail, most are

Differentiate the complex response
NO EXT only, DRO, or NCR

Implementation questions regarding FCT?
Tips: Teach a simple omnibus mand rather than try to teach specific mands for different reinforcers at first. Specific mands can be taught once problem behavior is zero and the omnibus mand is occurring independently. Rely on a novel mand rather than a pre-existing mand. Do everything possible to avoid chaining problem behavior with the target mand. For instance, be careful of prompting the novel mand after emission of pb Either let extinction of pb occur via time out or use an errorless prompting tactic such as most to least prompting Start out fast and sweaty; end slow and cool.

Come up with at least one question relevant to implementing Functional Communication Training (FCT)

Ten Unique Aspects of our Approach
9. We always explicitly teach delay/denial tolerance This takes up most of our time with children and families (not the functional assessment or teaching the FCRs) First teach an explicit response to a variety of disappointment signals, then to make treatment practical: Chain important behavior to the tolerance response (there is always a progressive component—a gradual increase in time, stakes, or both)

With only Progressive Reinforcement Delay:
As delay increases, FCR weakens & probability of PB increases As the delay increases, the newly acquired alternative response starts to diminish and, in this case, self-injury re-emerges.

Time-based vs. Contingency-based Progressive Delay (Lead Author: Mahshid Ghaemmaghami)
2 to 3 min delay

5 Critical Aspects of Delay/Denial Tolerance Training
Always provide immediate sr for some FCRs Teach an appropriate response to multiple cues of delay, denial, or disappointment Progressively increase the average amount of behavior (not just time) required to terminate the delay Terminate the delay for various amounts of behavior (sometimes expect very little behavior sometimes request larger or more complex types of behavior during the delay) Probably best to not signal how much behavior is required to terminate the delays How do we achieve high social acceptability ratings?

Nominate the critical features of programming to teach children to tolerate delays to the reinforcers maintaining their problem behavior. once compliance chains are acquired, always delay the reinforcer following a functional communication response teach an appropriate response to delay and denial cues by providing preferred candy when the child does not meltdown following a delay or denial cue end the delay when the amount of time determined prior to sessions has expired reinforce the functional communication response immediately at least some of the time end delays when the child has engaged in a sufficient amount of an appropriate activity

In this skill-based program, reinforcement is:
function-based as opposed to arbitrary differentially delivered as opposed to noncontingent continuous as opposed to intermittent consistent as opposed to variable in duration fairly unpredictable as opposed to highly predictable

Nominate the critical aspects of delay and denial tolerance training.
progressively increase the average amount of behavior required to terminate the delay teach an appropriate response to multiple cues of delay, denial, or disappointment always provide immediate reinforcement for some functional communication responses do not signal how much behavior is required to terminate the delays terminate the delay for various amounts of behavior

From the list below, nominate the items usually not necessary when implementing the treatment across the day: Laminate and laminating machine Glue guns Vis a vis markers Velcro Tokens and Token boards Timers Stickers Candies

Come up with at least one question relevant to implementing Delay/Denial Tolerance Training

Let’s review. Often, children, especially those diagnosed with autism, will engage in problem behavior and extended bouts of crying and tantrumming in order to retain or gain access to reinforcers. At best, some children repeatedly request their reinforcers when they are unavailable. Children will learn developmentally advanced mands (requests) best if they are highly motivated. Therefore, the success of this process relies on identifying powerful reinforcers. It is time to both prove the accuracy of your hunches described above as well as develop a motivating teaching context for the child. To accomplish these goals, describe either your functional analysis or mand analysis that will demonstrate the response-reinforcer relation and serve as your baseline from which to teach the tolerance repertoire. These both involve two distinct conditions. These both involve two distinct conditions. In the control condition, provide the reinforcers the whole time (do not remove them) during a 5 min session. In the test condition, attempt to remove the reinforcers, but give them back for 30 seconds immediately following any problem behavior or its precursors (functional analysis) or following any sort of mand for the reinforcers (mand analysis). Repeat removal and contingent reinstatement throughout the 5 min session. Alternate between control and test sessions until there is a reliable difference in the target behaviors (problem behavior and its precursors or mands) across conditions.

Treatment relies on set of reinforcers identified via the IISCA
Reinforcement is: Function-based Sr Examples: Access to attention and toys Escape from instructions to access preferred activities Escape from parent instructions to access preferred activities and to have people comply with his requests Termination of non-preferred conversations and access to preferred conversations Access to ritualistic behaviors Escape from discrete-trial work to child-led play with the teacher It is hard to communicate the essentials of the treatment in this short amount of time, so let me return to the treatment one more time prior to making my closing remarks. First point: The reinforcement we are using is function-based, meaning it is the same reinforcer we determined was maintaining problem behavior. And for us it is almost always a synthesis of multiple reinforcers. Here are some examples of common reinforcers identified through our functional assessment process.

Reinforcement is: Function-based Differential Problem Behavior Sr Simple FCR Sr Complex FCR Sr Complex FCR “No” Tolerance response Sr Second: We are relying on differential reinforcement in that neither problem behavior nor simple communication responses yield reinforcement; they are placed on extinction. *Reinforcement is provided only for complex communication, tolerance responses, or compliance with instructions or expectations. Complex FCR “No” Tolerance response Instruction Compliance Sr

Functional Communications
Reinforcement is: Function-based Differential Intermittent Complex Functional Communications Compliance 30% 50% Tolerance responses It is important to understand that reinforcement in this treatment is intermittent. We immediately reinforce communication responses about 30% of the time. We immediately reinforce tolerance responses about 20% of the time. And we reinforce various amounts of compliance 50% of the time. So reinforcement is intermittently provided for the important behaviors of communication, toleration, and compliance. 20%

Compliance Complex Functional Communications Compliance Tolerance
Reinforcement is: Function-based Differential Intermittent 10% Compliance Complex Functional Communications Compliance 10% Compliance 30% 10% Compliance Tolerance responses Because children sometime need to be without their reinforcers for short or extended amounts of time or said another way, children need to do various amounts of work, we end delays or reinforce when a child complies with very little demands, such as have a seat, lets do some work. And we sometimes don’t reinforce until a lot of work has been done. 20% 20%

Reinforcement is: Function-based Differential Intermittent
Complex FCR Sr Complex FCR Sr Complex FCR Sr Complex FCR “No” Tolerance response Sr Complex FCR “No” Tolerance response Sr Complex FCR This is a schematic of the various chains of behavior that yield reinforcement; schematic also indicates the relative probability each is reinforced. Take note of how often communication is always part of the chains of responses that yield reinforcement and how often tolerance responses will be practiced and reinforced as part of the interactional chains. “No” Tolerance response Instruction C Sr Complex FCR “No” Tolerance response Instruction Compliance Sr Complex FCR “No” Tolerance response Instruction Compliance Sr Complex FCR “No” Tolerance response Instruction Compliance Sr Complex FCR “No” Tolerance response Instruction Compliance Sr

Reinforcement is: Response requirement is: Function-based Variable
Differential Unpredictable Intermittent Complex FCR “No” Tolerance response Sr Complex FCR Sr Complex FCR “No” Tolerance response Instruction Compliance Sr Complex FCR “No” Tolerance response Sr Complex FCR “No” Tolerance response Instruction Compliance Sr Complex FCR This last schematic illustrates the treatment during implementation. It is important to understand that there is a variable and unpredictable response requirement. The child never knows which behavior will be reinforced because the response requirement for reinforcement, or how long the chain of behavior will be prior to reinforcement, is purposely unpredictable. This prepares children for the ambiguities of the real world, and as mentioned earlier, children seem to prefer conditions that retain this unpredictability or what we might call hope, hope that the things they have to do will be over at any second so that they can do what they would rather be doing. “No” Tolerance response Instruction C Sr Complex FCR Sr Complex FCR “No” Tolerance response Instruction Compliance Sr Complex FCR “No” Tolerance response Instruction Compliance Sr Complex FCR Sr

Reinforcement is: Response requirement is: Function-based Variable
Differential Unpredictable Intermittent Variable in duration Complex FCR “No” Tolerance response Sr Complex FCR Sr Complex FCR “No” Tolerance response Instruction Compliance Sr Complex FCR “No” Tolerance response Sr Complex FCR “No” Tolerance response Instruction Compliance Sr Complex FCR Look how much practice of the skills there are each time an EO is presented! We think it is these characteristics of the reinforcement program* that have led to the general and meaningful effects of our treatments. Seems complicated right? “No” Tolerance response Instruction C Sr Complex FCR Sr Complex FCR “No” Tolerance response Instruction Compliance Sr Complex FCR “No” Tolerance response Instruction Compliance Sr Complex FCR Sr

Treatment Implementation
Put these in your pocket Pull one out while child is experiencing their reinforcers Keep it to yourself Require that behavior next time Spin it! Keep it to yourself Require that behavior next time *Materials not needed: Laminate Laminating machine Glue guns Vis a vis markers Velcro Tokens Token boards Timers Stickers Candies Anything that was not already in the child’s environment! Based on the schematics I just showed, this sort of treatment may seem complicated to implement. But it isn’t. There are several strategies to ensure implementation with integrity. I prefer this low tech system. * You write the behaviors down that will yield the reinforcers, put them in your pocket, pull one out while the child is experiencing their reinforcers, keep the information to yourself please, and simply require that amount of behavior the next time the child initiates communication. Please appreciate that which is not required to implement this function-based treatment.

App called “Names in a Hat”
Based on the schematics I just showed, this sort of treatment may seem complicated to implement. But it isn’t. There are several strategies to ensure implementation with integrity. I prefer this low tech system. * You write the behaviors down that will yield the reinforcers, put them in your pocket, pull one out while the child is experiencing their reinforcers, keep the information to yourself please, and simply require that amount of behavior the next time the child initiates communication. Please appreciate that which is not required to implement this function-based treatment.

App called “Roundom” Based on the schematics I just showed, this sort of treatment may seem complicated to implement. But it isn’t. There are several strategies to ensure implementation with integrity. I prefer this low tech system. * You write the behaviors down that will yield the reinforcers, put them in your pocket, pull one out while the child is experiencing their reinforcers, keep the information to yourself please, and simply require that amount of behavior the next time the child initiates communication. Please appreciate that which is not required to implement this function-based treatment.

Come up with at least one question relevant to implementing the function-based treatment as described.

A final message With Autism, there is a higher likelihood of problem behavior Meltdowns Aggression Self-injury References: Baghdadli, Pascal, Grisi, & Aussilloux, 2003; Horner et al., 2002; Kim et al., 2000; Murphy, Healy, & Leader, 2009; Thompson, 2009 One final message: Recall that with Autism, there is a higher likelihood of problem behavior

is attainable from these behaviors
freedom from these behaviors for persons with Autism and their caregivers is attainable Although these problem behaviors are highly prevalent among those diagnosed with autism, freedom from these behaviors for persons with Autism and their caregivers is attainable. This is an important take home message to share with any parent of a child with autism, regardless of the child’s age or abilities.

It is attainable for most
without drugs without hospitalization without harsh punishment without candies, stickers, and token boards Be sure to tell them that freedom from problem behavior is attainable for most without

understanding can be realized quickly, safely, and analytically
It is attainable by first understanding* why the child is engaging in the problem behavior Freedom is attainable by first understanding why the child is engaging in the problem behavior. And my main point today was that this understanding can be and should be realized quickly, safely, and analytically. understanding can be realized quickly, safely, and analytically

*Communication and toleration
It is attainable when children are taught skills* to help them navigate our complex social world *Communication and toleration Sorry that I could not get into the details this morning, but I also believe that this freedom is only attainable when children are taught the skills of communication and toleration to help them navigate our complex social world.

It is attainable when the skills are maintained via unpredictable and intermittent reinforcement which is probably the same arrangement that maintained the various forms of problem behavior It is important to acknowledge also that freedom is attainable when children are taught the skills of communication and toleration to help them navigate our complex social world. There is a massive treatment buffet out there with options that are cold, old, and tasteless, and some options that will leave kids hungry, or make them sick. We have the skills and tools to prepare a well seasoned healthy meal for children with autism that will make them more fit than ever. Serve it up…..no one else can like you….serve it up.

The Treatment Buffet Professionals: You know when you look in journals and book chapters that there are so many treatment options out there for severe problem behavior. I call it the treatment buffet. Let’s remember that like most massive food buffets, there are many treatment options that are cold, old, and tasteless, and some options that will leave kids hungry, or even make them sick.

Teaching of academic, hygiene, play,
The Balanced Meal Teaching of academic, hygiene, play, & social skills Engagement in Independent play/work Functional communication We have the skills and tools to prepare a well seasoned, balanced meal for children with autism that will make them fit, allow them to learn and live with a sense of freedom, all while showing complete respect for their preferences. A balanced treatment. Serve it up folks, like only you can. Tolerance Access to toys, foods electronics, activities, stereotypy attention, breaks Compliance Compliance Compliance

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.

A Focus on a Safer, Faster, and Still Effective Process

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A Focus on a Safer, Faster, and Still Effective Process

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