Communication Skills Training Manual

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					   Using Functional Communication
Training to Reduce Aggressive Behavior
               in Autism

  American Speech-Language-Hearing Association Convention
                           Miami, FL
                       November 17, 2006




                   Miriam Chacon, M.S.
                    Oliver Wendt, PhD
                    Lyle L. Lloyd, PhD
               Department of Educational Studies
                      Purdue University
   Pervasive Developmental Disorder:
                  Autism
• Individuals with autism present with the
  following characteristics:
  • Deficits in social skills
  • Deficits in language & communication skills
  • Exhibit stereotypical behavior
                 (DSM IV, 2000)
                Challenging Behavior
Deficits in speech & language contribute to challenging behaviors
         which become the primary communication mode
                           Typically aggressive in nature

• Aggressive Behavior
    • defined as being hurtful to others (e.g., hitting, kicking, head-butting,
    spitting, slapping, pulling hair) or hurtful to self (SIB)


    • Self-Injurious Behavior (SIB)
         •self-aggression, forceful in nature, & may leave physical evidence (e.g., self-
         biting, pinching, hair pulling, scratching, slapping, hitting (with object/body
         part)
                                       (NIH, 1991)
        Functional Communication
             Training (FCT)
• Systematic intervention in which the challenging
  behavior is replaced by more socially appropriate
  behavior. (Sigafoos & Meikle, 1996)
  • Replacement behavior is intended to serve the same
    purpose as the challenging behavior. (Carr, 1988)
  • Underlying notion that challenging behaviors are
    communicative intents (Durand, 1993; Skinner, 1957)
               Purpose of Review
• Evidence Based Practice (EBP)
   • Provide evidence about the effectiveness of FCT for
     practitioners
   • Provide a systematic review which uses quantitative measures
     to determine treatment effectiveness
• Last review published in 1997 (Mirenda)
• Research Question
   • Is FCT an effective treatment in decreasing aggressive
     behaviors in individuals with autism?
                  Search Strategies
A comprehensive search strategy was used to locate intervention
  studies:
   • numerous databases (e.g., Academic Search Elite, ERIC, Medline,
     PsycINFO)
   • search engines (Google Scholar, MetaPress, & Science Direct)
   • other strategies (ancestry & journal hand searches)
• Keyword and keyword combinations used:
   • autism, self-injury, challenging behavior, aggression, functional
     communication training (FCT), functional equivalence training,
     developmental disabilities, response training, manual signs, graphic
     symbols, augmentative & alternative communication (AAC), self-abuse,
     problem behaviors
                Inclusion Criteria
Out of 24 studies, 10 met the inclusion criteria.
• FCT was operationally defined
• Subjects were diagnosed as having autism (other
  PDD’s excluded)
• Single-subject research design
   • True experimental design only, no pre-experimental
• Published in peer-reviewed journals from 1976 - 2005
• Aggressive behaviors were targeted in the intervention
                 Rejected Studies
• These articles met the initial keyword criteria.
  However, they were rejected upon careful review
  for one or more of the following reasons:
   •   Was not FCT but rather functional communication
   •   FCT was not the intervention
   •   Aggression was not the target behavior
   •   No intervention was implemented
               Accepted Studies
FCT only:                        FCT within a treatment package:
   • Braithwaite & Richdale         • Fisher et al. (2005)
      (2000)                        • Hagopian et al. (2005)
   • Day, Horner, & O’Neill         • Lalli, Casey, & Kates (1995)
      (1994)                        • O’Neill & Sweetland-Baker
   • Horner & Day (1991)              (2001)
   • Sigafoos & Meikle (1996)
   • Schindler & Horner (2005)
   • Wacker, et al. (1990)
          Non-parametric Measures

• Percentage of Non-overlapping Data (PND)
                      (Scruggs, Mastropieri, & Casto, 1987)

Mean PND:
      •   greater than 90% = highly effective
      •   between 70% - 90% = fairly effective
      •   between 50% - 70% = questionable effectiveness
      •   below 50% = unreliable treatments


• Percentage Reduction Data (PRD)
[(μB – μI) ÷ μB] x 100 = % reduction from baseline
                              PND

Calculate the percentage of
treatment data points that do not
overlap with the lowest (or highest)
baseline data points
Ex: 4/5 = 0.8 = 80%




                                       Campbell, 2004
                                  PRD

Calculate the mean of last 3 data points
for baseline (μB) & treatment (μI) then
subtract from each other, divide by μB
to obtain the percent reduction from
the baseline.
[(μB – μI) ÷ μB] x 100 = % reduction
from baseline
Ex: μB = (4 + 5 + 8) / 3 = 5.7
   μB = (3 + 0 + 0) / 3 = 1
 [(5.7 – 1) / 5.7] x 100 = 82%

                                           Campbell, 2004
                                        Analysis
The following replacement behaviors were identified:
• Speech (n=3)
   Vocalizations were used as the replacement behavior
     • Braithwaite & Richdale (2000)
     • Day, Horner, & O’Neill (1994)
     • Sigafoos & Meikle (1996)

• Manual Signs & Gestures (n=3)
   A combination of manual signs and gestures were used as the replacement behavior
     • Day, Horner, & O’Neill (1994)
     • Sigafoos & Meikle (1996)
     • Wacker, et al. (1990)

• Graphic Symbols (n=3)
   Graphic symbols were used as the replacement behavior
     • Horner & Day (1991)
     • Schindler & Horner (2005)
     • Sigafoos & Meikle (1996)
                     Analysis: Speech
                Vocalizations were used as the replacement behavior

          STUDY                  N         Condition                 PND (%)   PRD (%)

                                       Escape/Access
Braithwaite & Richdale, 2000     1      (“I want __ please”)
                                                                       97         100
                                       (“I need help please”)


Day, Horner, & O’Neill, 1994     1          Escape                    100         98
                                               (“go”)


                                     Attention/Access
  Sigafoos & Meikle, 1996                                              96         91
                                 1           (“Beth”)
                                      (“drink”, “toy”, “want”)


                                     Median                      =     97%        98%
Participants Total      n      = 3   Mean                        =     98%        96%

                                              (scores across all interventions)
       Analysis: Manual Signs & Gestures
 A combination of manual signs and gestures were used as the replacement behavior



         STUDY                 N          Condition                 PND (%)   PRD (%)


Day, Horner, & O’Neill,                    Access                    100       100
                                1
        1994                                 (want)


  Sigafoos & Meikle,                     Attention                   100       100
                                1
        1996                         (tapping teacher’s hand)



 Wacker, et al., 1990           1          Access                     50          49
                                         (touching chin)

                                     Median                     =    100%       100%
Participants Total       n = 3       Mean                       =    83.3%      83%

                                              (scores across all interventions)
       Analysis: Graphic Symbols
             Graphic symbols were used as the replacement behavior


         STUDY                  N         Condition           PND (%) PRD (%)

   Horner & Day, 1991           1          Escape                 46        <21
                                             (Break)

Schindler & Horner, 2005        1          Escape                 58            83
                                            (Activity)

                                1          Access                 72            92
Schindler & Horner, 2005               (preferred activity)

 Sigafoos & Meikle, 1996        1          Access                 100       100
                                        (food, drink, toy)

                                     Median                   =   65%           88%
Participants Total      n    = 4     Mean                     =   69%           74%
                                            (scores across all interventions)
                           Findings
• FCT ranged from fairly effective to highly effective in the studies
  reviewed
• FCT yielded greater reduction of challenging behaviors when
  speech & manual signs/gestures were used as the replacement
  behaviors
    • graphic symbols yielded the least amount of reduction


                                                  Median
                     TABLE                 PND             PRD
                     speech                 97%            98%
            manual signs & gestures        100%            100%
                graphic symbols             65%            88%
                   Limitations

• A small number of studies were analyzed
   • very specific inclusion criteria
• PND calculations had to be adjusted for some
  studies
   • outliers & unusual circumstances in the data reported in
     the studies
                Future Directions
• Master theses & dissertations are currently under
  review and will be included in the future
• Inclusion of studies in which FCT is part of a treatment
  package is warranted & will be analyzed
• Reliability analysis
   • Inclusion of study coding
• Use of 3rd statistic
   • Percentage of Zero Data (PZD) for measuring behavior
     reduction
• PRD needs to be developed further
   • no conventions available for score interpretation regarding
     degree of effectiveness
                                       References
Campbell, J. M. (2004). Statistical comparison of four effect sizes for single-subject designs. Behavior Modification,
     28(2), 234-246.
Carr, E. (1988). Functional equivalence as a mechanism of response generalization. In R. Horner, R. Koegel, & G.
     Dunlap (Eds.), Generalization and maintenance: Life-style changes in applied settings (pp. 221-241). Baltimore:
     Paul H. Brookes.
Carr, E., & Durand, V. M., (1985). Reducing behavior problems through functional communication training. Journal
     of Applied Behavior Analysis, 18, 111-126.
Centers for Disease Control and Prevention (2005). How common is Autism Spectrum Disorder (ASDs)? Retrieved
     November 13, 2005, from http://www.cdc.gov/about/default.htm.
Diagnostic and statistical manual of mental disorders (DSM IV) (4th ed.). (2000). Arlington, VA: American
     Psychiatric Association
Durand, V. M. (1993). Functional communication training using assistive devices: Effects on challenging behavior
     and affect. Augmentative and Alternative Communication, 9, 168-176.
Mirenda, P. (1997). Supporting individuals with challenging behavior through functional communication
    training and AAC: Research review. Augmentative and Alternative Communication, 13, 207-225.
National Institutes of Health (NIH) (1991). Treatment of destructive behaviors in persons with developmental
     disabilities. Washington, DC: Author.
Scruggs, T. E., Mastropieri, M. A., & Casto, G. (1987). The quantitative synthesis of single-subject research:
     Methodology and validation. Remedial and Special Education, 8(2), 24-33.
Sigafoos, J., & Meikle, B. (1996). Functional communication training for the treatment of multiply determined
     challenging behavior in two boys with autism. Behavior Modification, 20(1), 60-84.
Skinner, B. F. (1957). Verbal behavior. Englewood Cliffs, NJ: Prentice-Hall.
Wacker, D. P., Steege, M. W., Northup, J., Sasso, G., Berg, W., Reimers, T., Cooper, L., Cigrand, K., & Donn, L.
     (1990). A component analysis of functional communication training across three topographies of severe
     behavior problems. Journal of Applied Behavior Analysis, 23, 417-429.
    Articles Included in the Review
Braithwaite, K. L., & Richdale, A. L. (2000). Functional communication training to
    replace challenging behaviors across two behavioral outcomes. Behavioral
    Interventions, 15, 21-36.
Day, H. M., Horner, R. H., & O’Neill, R. E. (1994). Multiple functions of problem
    behaviors: Assessment and intervention. Journal of Applied Behavior Analysis,
    27, 279-289.
Horner, R. H., & Day, H. M. (1991). The effects of response efficiency on functionally
    equivalent competing behaviors. Journal of Applied Behavior Analysis, 24, 719-
    732.
Schindler, H. R., & Horner, R. H. (2005). Generalized reduction of problem behavior of young
    children with autism: Building trans-situational interventions. American Journal on Mental
    Retardation, 110, 36-47.
Sigafoos, J., & Meikle, B. (1996). Functional communication training for the treatment of multiply
    determined challenging behavior in two boys with autism. Behavior
    Modification, 20(1), 60-84.
Wacker, D. P., Steege, M. W., Northup, J., Sasso, G., Berg, W., Reimers, T., Cooper, L., Cigrand, K.,
    & Donn, L. (1990). A component analysis of functional
    communication training across three topographies of severe behavior problems.
    Journal of Applied Behavior Analysis, 23, 417-429.
        Additional Articles Accepted
                 FCT within a treatment package
            (data analysis not included in this review)
Fisher, W. W., Adelinis, J. D., Volkert, V. M., Keeney, K. M., Neidert, P. L.,
    Hovanetz, A. (2005). Assessing preferences for positive and negative
    reinforcement during treatment of destructive behavior with functional
    communication training. Research in Developmental Disabilities, 26, 153-168.
Hagopian, L. P., Kuhn, S. A., Long, E. S., & Rush, K. S. (2005). Schedule
    thinning following communication training: Using competing stimuli to
    enhance tolerance to decrements in reinforcer density. Journal of Applied
    Behavior Analysis, 38, 177-193.
Lalli, J. S., Casey, S., & Kates, K. (1995). Reducing escape behavior and
    increasing task completion with functional communication training, extinction,
    and response chaining. Journal of Applied Behavior Analysis, 28, 261-268.
O’Neill, R. E., & Sweetland-Baker, M. (2001). Brief report: An assessment of
    stimulus generalization and contingency effects in functional communication
    training with two students with autism. Journal of Autism and Developmental
    Disorders, 31(2), 235-240.
                                  Rejected Articles
Bird, F., Dores, P. A., Moniz, D., & Robinson, J. (1989). Reducing severe aggressive and self-injurious behaviors with
      functional communication training. American Journal on Mental Retardation, 94, 37-48.
Bondy, A. S., & Frost, L. A. (1998). The picture exchange communication system. Seminars in Speech and Language, 19(4),
      373-389.
Brown, K. A. et al. (2000). Evaluating the effects of functional communication training in the presence and absence of
      establishing operations. Journal of Applied Behavior Analysis, 33, 53-71.
Buckley, S. D., & Newchok, D. K. (2005). Differential impact of response effort within a response chain on use of mands in a
      student with autism. Research in Developmental Disabilities, 26, 77-85.
Carr, E. G., & Carlson, J. I. (1993). Reduction of severe behavior problems in the community using a multicomponent treatment
      approach. Journal of Applied Behavior Analysis, 26, 157-172.
Durand, V. M., & Merges, E. (2001). Functional communication training: A contemporary behavior analytic intervention for
      problem behaviors. Focus on Autism and Other Developmental Disabilities, 16(2), 110-119.
Kemp, D. C., & Carr, E. G. (1995). Reduction of severe problem behavior in community employment using an hypothesis-
      driven multicomponent intervention approach. JASH, 20(4), 229-247.
Koegel, L. K., Stiebel, D., & Koegel, R. L. (1998). Reducing aggression in children with autism toward infant or toddler
      siblings. JASH, 23(2), 111-118.
McCord, B. E., Thomson, R. J., & Iwata, B. A. (2001). Functional analysis and treatment of self-injury associated with
      transitions. Journal of Applied Behavior Analysis, 34(2), 195-210.
Mirenda, P. (1997). Supporting individuals with challenging behavior through functional communication training and AAC:
      Research review. Augmentative and Alternative Communication, 13, 207-225.
Polirstok, S. R., Dana, L., Buono, S., Mongelli, V., & Trubia, G. (2003). Improving functional communication skills in
      adolescents and young adults with severe autism using gentle teaching and positive approaches. Topics in Language
      Disorders, 23(2), 146-153.
Symons, F. J., Fox, N. D., & Thompson, T. (1998). Functional communication training and naltrexone treatment of self-
      injurious behaviour: An experimental case report. Journal of Applied Research in Intellectual Disabilities, 11(3), 273-293.
Tincani, M. J., Castrogiavanni, A., & Axelrod, S. (1990). A comparison of the effectiveness of brief versus traditional functional
      analyses. Research in Developmental Disabilities, 20(5), 327-338.
Thompson, R. H., Fisher, W. W., Piazza, C. C., & Kuhn, D. E. (1998). The evaluation and treatment of aggression maintained
      by attention and automatic reinforcement. Journal of Applied Behavior Analysis, 31(1), 103-116.
         Contact Information

• Primary Author:
    Miriam Chacon, doctoral student
    Purdue University
    100 N. University Street, BRNG 5163
    West Lafayette, IN 47907-2098
    (765) 494-9668 (office)
    mchacon@purdue.edu
            Acknowledgements
• The authors would like to thank the Purdue
  University AAC Group for the editorial
  contributions and suggestions.
• Funding support provided by:
   • ASHA Student Research Travel Award
   • Department of Educational Studies, Purdue University
   • College of Education, Purdue University

				
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