Function-Derived Treatment Options Objectives

139

4Function-Derived Treatment Options Objectives

• Students will be able to identify functional treatment options for the DA 1.1 and 1.2 functions, and detail the procedures for the conduct of such with respect to the designated functional category

• Students will delineate the role of chain interruption for DA and DE functions

• Students will be able to identify functional treatment options for the SMA 2.1, 2.2, and 2.3 functions, and detail the procedures for the conduct of such with respect to the designated functional category

• Students will delineate the role of extinction for SMA and SME functions

• Students will be able to identify functional treatment options for the DE 3.1, 3.2, 3.3, and 3.4 functions, and detail the procedures for the conduct of such with respect to the designated functional category

• Students will be able to identify functional treatment options for the SME 4.1, 4.2, 4.3, and 4.4 functions, and detail the procedures for the conduct of such with respect to the designated functional category

• Students will be able to conduct a trigger analysis to assess the possible severity of an extinction burst

• Students will be able to identify the three classification categories in the Cipani Replacement Function Classification System for replacement functions, and contrast them with the diagnostic criteria for each

• Students will be able to conduct an experimental analysis with two designated conditions to determine if a selected behavior for the replacement function is currently at minimal rate due to misdirected contingencies or inept repertoire

Chapter 4 Behavior Analysis Certification Board (BACB) Task List

4th edition 5th edition • J-02 Identify potential

interventions based on assessment results and the best available scientific evidence

• G-1 Use positive and negative reinforcement procedures to strengthen behavior.

• G-2 Use interventions based on motivating operations and discriminative stimuli.

(continued )

Cipani, E. P. (2017). Functional behavioral assessment, diagnosis, and treatment, third edition : a complete system for education and mental health settings. Retrieved from http://ebookcentral.proquest.com Created from snhu-ebooks on 2018-10-25 18:47:37.

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140 Functional Behavioral Assessment, Diagnosis, and Treatment

This chapter will examine how to select and design a function-derived treatment. The designation of the treatment requires two contingency considerations. First, the function of the problem behavior should be significantly hampered and disabled. Concurrently, the replacement function involves an alternate behavior(s) that should be enabled under a specified establishing operation (EO). The latter contingency design features are often referred to as the “replacement behavior.” These two sets of considerations will be presented for each of the major categories. A number of potential treatment options will be posed for the four major functions: direct access (DA), socially mediated access (SMA), direct escape (DE), and socially mediated escape (SME). Throughout this chapter, a “text box” is used to highlight the basic rearranged contingencies for treating a problem behavior and its function with the selected treatment option. Finally, a three-category diagnostic system to determine the strength of the behavior(s) to serve in the replacement function will be presented.

4th edition 5th edition • J-04 Select intervention

strategies based on client preferences

• J-05 Select intervention strategies based on the client’s current repertoires

• J-06 Select intervention strategies based on supporting environments

• J-10 When a behavior is to be decreased, select an acceptable alternate behavior to be established or increased

• D-06 Use chaining

• D-11 Use mand training

• D-21 Use differential reinforcement (e.g., DRO, DRA, DRI, DRL, DRH)

• D-18 Use extinction

• E-10 Use the Premack principle

• I-04 Design and implement the full range of functional assessment procedures

• I-05 Organize, analyze, and interpret observed data

• I-06 Make recommendations regarding behaviors that must be established, maintained, increased, or decreased

• G-3 Establish and use conditioned reinforcers.

• G-7 Use shaping.

• G-8 Use chaining.

• G-9 Use discrete-trial, free-operant, and naturalistic teaching arrangements.

• G-14 Use reinforcement procedures to weaken behavior (e.g., DRA, FCT, DRO, DRL, NCR).

• G-15 Use extinction.

• H-1 State intervention goals in observable and measurable terms.

• H-2 Identify potential interventions based on assessment results and the best available scientific evidence.

• H-3 Recommend intervention goals and strategies based on such factors as client preferences, supporting environments, risks, constraints, and social validity.

• H-4 When a target behavior is to be decreased, select an acceptable alternative behavior to be established or increased.

• H-5 Plan for possible unwanted effects when using reinforcement, extinction, and punishment procedures.

• H-6 Monitor client progress and treatment integrity.

• H-7 Make data-based decisions about the effectiveness of the intervention and the need for treatment revision.

• H-8 Make data-based decisions about the need for ongoing services.

• H-9 Collaborate with others who support and/or provide services to clients.

(continued )

Cipani, E. P. (2017). Functional behavioral assessment, diagnosis, and treatment, third edition : a complete system for education and mental health settings. Retrieved from http://ebookcentral.proquest.com Created from snhu-ebooks on 2018-10-25 18:47:37.

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4 Function-Derived Treatment Options 141

WHAT IS A REPLACEMENT BEHAVIOR? When treating problem behaviors, one must decrease the target unacceptable behaviors while selecting an alternate desirable behavior, termed a replacement behavior, for specific reinforcement. A replacement behavior serves the same environmental function as a problem behavior. Therefore, a replacement behavior cannot be designated without an understanding of the target behavior’s function under specific antecedent contexts (EO & discriminative stimuli). The selected replacement behavior must be capable of producing the same reinforcer as the problem behavior in the identified contexts. The hypothetical example depicted in Table 4.1 illustrates how an alternate, more appropriate form of behavior can replace the current function of the problem behavior.

The designation of the three possible replacement behaviors in Table 4.1 stipulates that each replacement behavior must result in the delivery of the reinforcer. For example, in the first replacement behavior, requesting the toy (from another child) must produce the desired toy at some high level of probability. One cannot simply announce that requesting behavior is an alternate replacement behavior for this child instead of grabbing a toy. Without ensuring that reinforcement will ensue for requesting the toy, the target behaviors may still be more functional than the current designated means for obtaining reinforcement. If the requests are not honored reliably, requesting behavior will not function effectively to access reinforcement.

TABLE 4.1 n EXAMPLE OF ALTERNATE REPLACEMENT BEHAVIORS

Problem Behavior: Under the conditions of wanting a toy that another child is using, the target child gets the toy from the other child (consequence) by grabbing the toy (behavior problem) and running away with the toy (DA 1.2: Tangible Reinforcers).

Goal: Decrease the target inappropriate behavior, which is, grabbing the toy from someone else and running away with the toy. Increase an alternate appropriate behavior given the same context.

Possible Appropriate Replacement Behaviors:

1. Requesting toy Desired Contingency: Child gets the toy from another child (consequence) by asking nicely if he can play with the toy, and other child gives the toy upon request. The request needs to be honored for such a replacement behavior to be naturally maintained. Further, grabbing the toy results in loss of access to the toy immediately, by adult removing the child from the toy and play area.

2. Offering to play together Desired Contingency: Child shares the toy with another child (consequence) by asking nicely if he or she can play with the toy with that child. The request to share the toy needs to be honored for such a replacement behavior to be naturally maintained. Again, grabbing the toy results in loss of access to the toy immediately, by adult removing the child from the toy and play area.

3. Getting another toy, while waiting for the desired toy to become available Desired Contingency: Adult specifies time period each child wanting a certain toy will have, e.g., 2 minutes. The target child waits or gets another toy during the interim period. When it is his or her turn to play with the desired toy, he or she is given access by adult requiring the other child to relinquish the toy, and the target child gets a certain amount of time with the toy, e.g., 2 minutes.

Cipani, E. P. (2017). Functional behavioral assessment, diagnosis, and treatment, third edition : a complete system for education and mental health settings. Retrieved from http://ebookcentral.proquest.com Created from snhu-ebooks on 2018-10-25 18:47:37.

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142 Functional Behavioral Assessment, Diagnosis, and Treatment

Requesting then becomes a less probable behavior under these circumstances. Meanwhile other behaviors will be exhibited in attempts to get the toy.

Further, the prior functional target behavior, that is, grabbing the toy from another child, must not be allowed to succeed. Such behavior, when exhibited, must result in immediate removal of the toy from the target child. Further, the loss of access to that toy (and others) for a period of time must be invoked. This contingency for grabbing behavior must be in place in order for any potential replacement behaviors to have a chance at becoming functional. Allowing this child to grab a toy from another child without such a contingency dooms the development of alternate behaviors to failure. The removal of the toy must be immediate! If the adult argues with the child, this contingency is considerably weakened, and grabbing toys from other children becomes strengthened relative to more appropriate behaviors.

Similarly, sharing the toy upon request (second example) must also be honored if it is going to take the place of grabbing a toy. Further, the target child’s enjoyment of the sharing of the toy must parallel the reinforcing magnitude of playing with the toy in isolation. Sharing versus playing alone, even with the same toy, are not the same events. Hence, the reinforcing potency of the sharing context needs to be evaluated as being as powerful as playing alone. If it is not as pleasurable, engaging in a request to share will probably not replace grabbing the toy.

Finally, teaching the child to wait for a period of time before getting the desired toy will be effective only if grabbing the toy never (or rarely) produces access to the toy. Therefore, the previously stipulated contingency for toy grabbing must be in place. In addition, the ability to delay gratification often needs to be systematically developed. This plan would probably require a progressive manner of teaching “waiting behavior.”

Suppose access to a toy was achieved through an adult via tantrum behavior (i.e., instead of grabbing the toy)? The diagnostic category for this target behavior is SMA 2.3: Tangible Reinforcer. What might be some of the options for an alternate replacement behavior? Table 4.2

TABLE 4.2 n EXAMPLE OF ALTERNATE REPLACEMENT BEHAVIORS FOR TANTRUM BEHAVIOR

Problem Behavior: When the child desires a toy that someone else has, the child gets the toy from the caregiver (consequence) by throwing a tantrum for several minutes (behavioral problem).

Goal: Decrease the target inappropriate behavior, i.e., tantrum behavior. Increase an alternate appropriate behavior given the same context.

Appropriate Replacement Behaviors:

1. Request toy from caregiver Desired Contingency: The child is given the toy by the caregiver (consequence) after an appropriate request is made for the toy. The request needs to be honored for such a replacement behavior to be naturally maintained. Further, if the child engages in tantrum behavior, such results in a period of time where the desired toy is made not available. (Note: This program should also be supplemented with a delay of gratification training option, to be presented in this chapter.)

2. Finish task or chore first Desired Contingency: The child is given the toy by the caregiver (consequence) after the child completes the task or chore assigned (Premack contingency). Completing the chore needs to be honored as the requisite event for accessing the toy. Further, tantrum behavior sets up a period of time whereby the desired toy is not available.

Cipani, E. P. (2017). Functional behavioral assessment, diagnosis, and treatment, third edition : a complete system for education and mental health settings. Retrieved from http://ebookcentral.proquest.com Created from snhu-ebooks on 2018-10-25 18:47:37.

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4 Function-Derived Treatment Options 143

illustrates two possible alternate replacement function options for the designated SMA function of the target behavior of tantrums, that is, access to the toy. In the first option, an appropriate request will replace the tantrum behavior in terms of toy access function. If the child throws a tantrum, he or she does not get the toy. If the child requests the toy in an appropriate tone of voice, he or she gets the toy.

In the second option, performing a required task or chore is a conditional event prior to getting the toy. It is again essential that completion of the task results in accessing the toy, while ensuring that the tantrum behavior does not produce the toy (or minimally, produces the toy less effectively and efficiently than completing the chore; see Table 4.2). Note how both examples select an alternate appropriate behavior that can serve the same function (i.e., produce the same reinforcer) as the problem behavior. Once the replacement behavior is developed in the client’s repertoire, it will replace the function or purpose of the problem behavior. This will occur only if the dual contingency exists: The replacement behavior achieves reinforcement, while the target problem behavior is significantly less functional, or nonfunctional, in achieving the desired result. Table 4.3 presents the steps to utilize in identifying a functional replacement behavior.

DISABLE ONE FUNCTION, ENABLE ANOTHER Too often, many inexperienced attempts at developing a replacement behavior involve simply specifying that some selected behavior should replace the target behavior. People who espouse such declarations do not seem to grasp or comprehend the nature of behavior with respect to antecedent and consequent stimuli. To accomplish the successful transition from a currently functional target problem behavior becoming nonfunctional and a currently nonfunctional appropriate behavior becoming functional, social control over the maintaining contingencies is required!

Target behavior Eliminate or disable current function Replacement behavior Enable and enhance desired environmental function

For example, a referral is made for a male client who hits people on the shoulder while sitting on the couch and watching TV in a group home for persons with disabilities. One of the program managers decides that the replacement behavior should be the following: have this client put his hands in his pockets while he is on the couch. That certainly sounds good because it is a state of affairs that is incompatible with hitting people on the couch. However, it offers little in the way of understanding why the hitting behavior occurs (i.e., maintaining contingency under a specific EO). Suppose the hitting occurs because the person next to the target client is talking, and hitting him makes him shut up. Is it reasonable to expect this client will keep his hands in his pockets the next time his listening to the TV program is interrupted? I believe the hands will come out of the pocket and deliver the shot that produces cessation of talking from his neighbor. Then the hands will probably go back into the pockets.

TABLE 4.3 n THE STEPS TO IDENTIFYING REPLACEMENT BEHAVIORS

• Identify the diagnostic category of problem behavior by assigning it to one of the four major diagnostic categories (and sub-categories) presented in Chapter 3.

• Identify the specific reinforcers that result from the occurrence of the problem behavior (Chapter 3), under the prevailing motivational conditions (EOs) and antecedent contexts.

• Designate an alternate appropriate behavior(s) or behavioral criteria that will be made to produce the same function as the problem behavior in the identified antecedent social contexts, whether naturally or contrived.

• If the problem behavior serves more than one function, identify the different functions for each antecedent context and repeat above steps for each unique source of stimulus control.

Cipani, E. P. (2017). Functional behavioral assessment, diagnosis, and treatment, third edition : a complete system for education and mental health settings. Retrieved from http://ebookcentral.proquest.com Created from snhu-ebooks on 2018-10-25 18:47:37.

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144 Functional Behavioral Assessment, Diagnosis, and Treatment

In summary, the behavior analyst needs to produce two changes in the client or child’s environment. First, the target behavior’s current function needs to be disabled or severely impaired by manipulating those current maintaining contingencies (i.e., function). Equally important, the alternate appropriate behavior needs to be enabled in producing the desired environmental function previously produced by the target behavior under relevant motivational conditions.

In this chapter, we present several replacement function options for developing an alternate manner of producing the desired result (i.e., abolishing operation). Determining what the maintaining contingencies are for the problem behavior as well as the current strength of the potential replacement behavior is at the heart of designing an effective functional treatment. The following material presents several functional treatment options for each major diagnostic category for problem behavior: DA 1.0, SMA 2.0, DE 3.0, and SME 4.0. Of course, removal of the problem behavior’s maintaining reinforcer is implicit within each of these options.

REPLACEMENT FUNCTION OPTIONS FOR DA PROBLEM BEHAVIORS There are four replacement function options when treating a target problem behavior that is maintained by to directly contacting the positive reinforcer. In some parts of this chapter, we have slightly altered the term, “replacement behavior,” to embrace a synonymous term, “replacement function.” Some of the options presented below do not have a distinct “replacement behavior.” Rather the intervention strategy produces the desired outcome when a behavioral criterion or standard is achieved, which may involve the absence of the problem behavior (e.g., delay of gratification training). This modification allows the designated term to encompass a desired function rather than identifying just a behavior. All four options require the chain interruption strategy as a component to address client attempts to actually engage in the prohibited target behavior, when unauthorized.

Alternate DA form replacement option: Identify an alternate, more acceptable form of behavior (one that is not as inappropriate or dangerous) that directly produces the same specific reinforcer.

Access mand (request) replacement option: Identify a requesting behavior (mand) that would allow staff to mediate such a request or choice by providing the client with a more appropriate setting (area) in which to engage in the problem behavior (if the problem behavior is not dangerous, but is merely inappropriate in form).

Delay of gratification training option (differential reinforcement of other behavior [DRO]): Identify a length of time that you want the individual not to perform the target DA behavior, that is, the nonoccurrence of behavior for a set time period. Contingent upon the individual not engaging in the target problem behavior for that time period, access to the specific reinforcer is provided, either by request or by direction of staff (functional treatment option rather than a discrete replacement behavior).

Premack contingency replacement option (engagement in lower probability behaviors as the contingency for access to a specific reinforcer): Identify a regimen of tasks that, when completed, allows the client to access the specific reinforcer (consider this criterion for reinforcement access as a chain of sequenced performances).

Chain Interruption Strategy Chain interruption involves interrupting or blocking the performance of the behavior at its earliest onset. In conjunction with the target replacement function to develop an alternate mechanism, a chain interruption strategy as a contingency is essential for DA problem behaviors. In order for the problem behavior to be ameliorated, it must be weakened in its ability (i.e., disabled) to directly contact the sensory or tangible reinforcer.

Although many professionals espouse the deployment of developing a replacement behavior, they often overlook what must be done to behaviors that produce positive (or negative) reinforcement directly. If the client is not prevented from engaging in the DA behavior, then the

Cipani, E. P. (2017). Functional behavioral assessment, diagnosis, and treatment, third edition : a complete system for education and mental health settings. Retrieved from http://ebookcentral.proquest.com Created from snhu-ebooks on 2018-10-25 18:47:37.

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4 Function-Derived Treatment Options 145

desired sensory or tangible reinforcer is contacted ad lib. The replacement behavior option will thus be rendered less functional (i.e., less effective and efficient). As a result, the client will not engage in that designated replacement behavior to access reinforcement.

Therefore, it is essential that you interrupt the target behavior before it contacts reinforcement, or at least before a certain amount or duration of access is attained. For example, if the client is mouthing inedible objects because of the oral stimulation it produces, such a direct behavior-reinforcement relationship would need to be greatly impeded via chain interruption or blocking. Attempts to physically stop the client from placing the object in the mouth are necessary. If the client is stopped only after gnawing on the object for a while, it is too late! Sensory reinforcement has already been achieved. Impeding such a response– reinforcer relationship is critical to the success of any treatment plan.

The staff must become more vigilant in detecting the initial parts of this behavior and interrupting it. Their efforts may be met with the client becoming stealthier in engaging in this behavior. However, the effort to make such a DA to positive reinforcement function more arduous will be essential for the selected replacement behavior to become functional. The replacement behavior option must successfully access sensory reinforcement, while the target problem behavior is obstructed frequently. If staff can fulfill that requirement, the replacement behavior option will increase in frequency while the DA problem behavior will decrease.

Concurrent with the chain interruption strategy, a strategy for developing or increasing an alternate replacement behavioral function needs to be designed. Each of the following four options may be considered. In some cases, one option may be more suited for a specific context and setting than others. This needs to be a clinical decision.

DISCUSSION QUESTION 4A Why is it necessary to implement a chain interruption procedure for problem behaviors that serve DA and DE functions?

Alternate DA Form Option In some cases, it is possible to identify an acceptable replacement behavior that varies slightly in topography from the problem behavior but still produces directly the same desired result. In a prior example, a client with severe intellectual disabilities ran to the door, swung it wide open, and ran outside. The maintaining reinforcer for this inappropriate chain of behaviors was getting to go outside. A more acceptable alternate behavior can be walking out the door (not running), and then exiting with staff supervision. Engaging in any previous form of exiting would result in staff stopping the client and delaying access to outside until the behavioral form occurs. The rearranged contingencies are delineated in Table 4.4.

Suppose we determine that sticking inedible things in one’s mouth is maintained by a DA to the ingestion of edible items. A replacement behavior that alters the form to be more acceptable while maintaining the same access to the reinforcer is illustrated in Table 4.5.

The following case examples are further illustrations of the use of this replacement function option.

Pushing and Shoving. A male client was referred to me for behavioral consultation as a result of his pushing and shoving staff in order to get to the refrigerator. He lived in a residential facility with five other adults with autism. You probably think he is going into the refrigerator to get something out to eat or drink. Such was not the case. Once he opened the refrigerator, he would check to see if the lunch bags for the next day were made and placed in their correct space.

Why would he push and shove staff in order to get to the refrigerator? This behavior was the result of staff preventing him from engaging in his obsession with “checking on the lunches.” He learned to run because staff were very good at encumbering a more leisurely approach. Simply walking over to the refrigerator to check out the lunch bags would only result in his being sent back to the living room area. He thereby learned to become both quicker and more aggressive in achieving his goal of getting to the refrigerator. You can see that pushing

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146 Functional Behavioral Assessment, Diagnosis, and Treatment

or shoving staff and running past them when they were not looking was more functional in this circumstance, given the staff ’s predilection toward preventing access to the refrigerator.

The replacement behavior identified for this client was walking appropriately to the refrigerator. He was taught to engage in such behavior, with the result being unobstructed access to the refrigerator. Given his previous history, this behavior had to be prompted for a while. If he walked appropriately to the kitchen, he was allowed to open the refrigerator door and check out the sack lunches. If he ran, pushed, or shoved anyone, he would not get to open the door at that time and was required to return to the area where the running began. He was then to demonstrate the appropriate walking behavior, which resulted in his being allowed to open the refrigerator door. Of course, pushing and shoving would decrease once such behaviors only postponed his access to the refrigerator.

A Unique Sensory Reinforcer Replacing the function of the problem behavior may sometimes be difficult with a problem behavior diagnosed as DA 1.1: Immediate Sensory Stimuli. A more acceptable form that does not produce DA to the positive reinforcer will not replace the problem behavior’s function. Although you may think that the two are equivalent, in the eyes of the client they are not. Here is a case in point.

TABLE 4.5 n ACCEPTABLE FORM

Functional Treatment: DA 1.1: Immediate Sensory Stimuli

Contingency Plan for Target Behavior: If the student attempts to stick inedible items in his or her mouth, the student will be physically prevented from achieving such a result, if possible. Additionally, a 3-minute removal from environment (place him or her in a chair where access to any object is precluded) should be effected before prompting the replacement behavior. The function of this 3-minute time-out is to make such attempts less functional and more arduous in getting edible items (i.e., disabling the function).

Contingency Plan for Replacement Behavior: If the student walks over to the basket where there is food, he or she may eat in peace. This option would be considered for clients who do not have problems with weight, such as obesity.

TABLE 4.4 n REARRANGED CONTINGENCIES

Functional Treatment: DA 1.2: Tangible Reinforcer

Contingency Plan for Target Behavior (Chain Interruption): If engaging in the target behavior (running outside), the client will be stopped and brought back immediately to the start point. The client will be required to wait a period of time, for example, 1–2 minutes, before being prompted to perform the alternate behavior. Of course staff have to be close to catch any inappropriate exiting behavior immediately, upon which they will perform this regimen.

Contingency Plan for Replacement Behavior: If the student signs “out,” he or she will be allowed to go outside if walking appropriately. Student may need staff to prompt such behaviors in contrast to running, as well as massed trials of practice (if replacement behavior diagnosis is inept repertoire; see Inept Repertoire Category section of this chapter).

Cipani, E. P. (2017). Functional behavioral assessment, diagnosis, and treatment, third edition : a complete system for education and mental health settings. Retrieved from http://ebookcentral.proquest.com Created from snhu-ebooks on 2018-10-25 18:47:37.

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4 Function-Derived Treatment Options 147

In the early 1980s, a female client was referred to me for a behavioral plan for an extremely revolting and undesirable behavior. In her day treatment program, she would grab feces left in the toilet bowl from her own use or someone else’s and squish it in her hands. The first plan set up at the program was to prevent her from doing this. The day treatment aides were to restrain her from engaging in such a behavior. Unfortunately, this plan did not work to make her value the activity less. In fact, it seemed to only deprive such an event and make the motivational condition to access it stronger. Such an increased desire on the client’s part to get to the bathroom further compounded the staff ’s problem in managing her. Use of the bathroom by other clients was a signal to her that the desired activity may be available. She would then dash to the toilet to determine whether something was left in the toilet bowl from the last user. Because she was now being prevented from going to the bathroom at these times, she began to engage in aggressive and disruptive behavior toward staff when they tried to restrain her from engaging in this behavior. Further, she became more capable of discerning times when staff would be less vigilant and a mad dash to the bathroom might pay off. When another client was engaged in tantrum behavior and staff were involved in some extensive management procedure, she would dart toward the bathroom. Hence, another client’s problem resulted in staff having to deal with two problems.

My analysis of this behavior supported a DA function (DA 1.1: Immediate Sensory Stimuli). The client seemed to like the sensation of squishing the feces in the toilet bowl. I am not sure why this was pleasurable to her, but it certainly seemed that the behavior was producing its own reinforcer. The replacement behavior that was targeted for reinforcement involved the same form of the behavior. When she completed a designated number of tasks, she earned a specified amount of free time. She was then allowed to go to the bathroom and squish feces! However, prior to going to the bathroom, disposable rubber gloves were placed on her hands. She then engaged in the squishing behavior, with the gloves on. When her free time elapsed, she took the gloves off and disposed of them in the garbage can in the bathroom. She then washed her hands thoroughly before going back to the work area. She resumed her work on tasks to earn more free time. Data indicated that the rate of running to the bathroom to “check it out” reduced to zero, as did the wrestling matches with the staff. Her work production was maintained at high levels.

Why was this form chosen and not something else? Suppose we had set up a program that allowed her to squish play dough instead? That certainly would be more appropriate than squishing feces in her hands, even with gloves on. However, squishing play dough may not have resulted in the same sensory reinforcer. Therefore, allowing her access to play dough may not have been equivalent from her perspective. Hence, such a contingency may have had no effect on the rate of the target behaviors, that is, running to the bathroom unauthorized to squish feces with one’s bare hands.

In the designated plan, the form of the replacement behavior left the sensory reinforcer intact, for the most part. Despite the repugnant aspect of this behavior, the designed program had two critical effects. First, it did remove sanitary concerns in regard to the sensory maintained behavior. Second, it resulted in a reduction of the target behavior occurrence to zero for many days. Contrast this with the result obtained when staff tried to obstruct her access to the reinforcer: frequent incidents of aggression and running to the bathroom. Finally, her obsession with this ritual decreased over time until it was not something she chose to do during earned free time.

Don’t Jump! The client mentioned earlier who jumped out of his wheelchair could also have accessed floor time in another manner. If a graded platform was built, he could have been taught to hoist himself up on the top of the platform and then gradually slide down (similar to a children’s slide on the playground). This option would have been easier on the staff. Getting into his wheelchair might have been achieved by a reverse process, that is, him moving himself up the graded platform.

Access Mand (Request) Option In some cases, it may be possible to teach the individual to request permission to engage in the desired activity (a mand). A request or mand need not be vocal; it could be a manual sign or gesture, such as pointing to a symbol or picture. The only requirement on the form of the request is that it is reliably translated by the receiver of the message.

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148 Functional Behavioral Assessment, Diagnosis, and Treatment

FUNCTIONAL TREATMENT: DA 1.1: IMMEDIATE SENSORY STIMULI

Contingency Plan for Target Behavior (chain interruption) Interrupt initial chain of stereotypic behavior. Removal for several minutes from any opportunity to perform such behavior (chain interruption).

Contingency Plan for Replacement Behavior Prompt client to request (in whatever designated form) access to desired activity or event. Contingent upon request, provide client access to desired activity in a designated setting. With some behaviors diagnosed as DA 1.1 (e.g., masturbation, nose picking), the area should be private, away from others seeing the client.

This option is particularly suited where the form of the behavior is not dangerous or unhealthy but is unacceptable in some contexts. Contingent upon a request, staff can then provide an appropriate place for the student or client to engage in the behavior. For example, some stereotypic or self-stimulatory behaviors can be treated effectively by teaching the client to request (vocally or nonvocally) the opportunity to engage in those behaviors. Contingent upon this request, the staff can then direct the client to a private area. One must make sure that the request is honored by staff in a timely manner, especially in the beginning of the program. If the request is not honored, or is delayed to a significant extent, then requesting behavior will not be functional. One would expect that the request will never fully be able to compete with engaging in the stereotypic behavior ad lib. It is therefore important that the dual contingency be operable. The following contingency box illustrates this requirement.

FUNCTIONAL TREATMENT: DA 1.2: TANGIBLE REINFORCER

Plan for Target Behavior If the client shows signs of attempting to jump out of the wheelchair, he will be physically prevented for a period of 5 minutes subsequently.

Contingency Plan for Replacement Behavior With some initial prompting, the client is taught how to wheel his chair over to the platform and engage in a series of physical movements that result in his propping himself onto the platform, and then gradually traversing down the platform safely.

Here is another example of this treatment option. Suppose a client frequently runs out of a female residential facility and lacks safety skills involving roads and cars. She leaves the facility simply to get outside. Such is not an unreasonable behavior because one can stay inside only for so long before wanting to have a change in scenery. However, her unauthorized and spontaneous leaving the facility without staff supervision is a definite serious problem, given her inability to navigate roads and cars safely.

Suppose the client is taught to request an outside activity (with staff supervision) by signing “walk.” When she wants to go outside, she would be prompted to sign “walk.” The staff would then take her hand and let her guide them to the area she wished to go to. This allows her to get outside the house, but with the necessary staff supervision.

The following are some additional illustrations of the mand option with prior clinical examples:

I Need a Change of Clothing. A male client rips off his clothes occasionally because he doesn’t like the clothes he has on. Rather, he prefers other clothes. You can see that reinforcing a request for new clothes, or allowing him to choose which clothes to wear in the morning for work or school, is more preferable from a management perspective than the current “clothes ripping” behavior.

Cipani, E. P. (2017). Functional behavioral assessment, diagnosis, and treatment, third edition : a complete system for education and mental health settings. Retrieved from http://ebookcentral.proquest.com Created from snhu-ebooks on 2018-10-25 18:47:37.

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4 Function-Derived Treatment Options 149

FUNCTIONAL TREATMENT: DA 1.2: TANGIBLE REINFORCER

Contingency Plan for Target Behavior (chain interruption) If the client engages in the target behavior (runs outside), she will be brought back immediately and required to wait a period of time, for example, 1 to 2 minutes, before being prompted to perform requesting behavior. If she is caught running before getting outside, the same contingency is in effect.

Contingency Plan for Replacement Behavior If she signs “walk,” she will be allowed to go outside if she walks appropriately with staff. Staff should prompt such behaviors initially to replace running outside, as well as massed trials of practice (if replacement behavior diagnosis is inept repertoire; see Inept Repertoire Category section of this chapter).

FUNCTIONAL TREATMENT: DA 1.2: TANGIBLE REINFORCER

Contingency Plan for Target Behavior (chain interruption) If the client begins to engage in the initial forms of the target behavior (tearing at clothes), he or she will be physically stopped (immediately) and required to wait a period of time, for example, 1 to 2 minutes, before being allowed to engage in an alternate behavior.

Contingency Plan for Replacement Behavior If the student signs “new clothes,” he or she will be allowed to procure a choice of clothes to wear. The student may need staff to prompt such a request immediately when forced to wear undesired clothes, as well as massed trials of practice (if replacement behavior diagnosis is inept repertoire; see Inept Repertoire Category section of this chapter).

One should realize that developing these specific communicative behaviors will be functional only if the DA 1.2: Tangible Reinforcer diagnosis was accurate. Suppose clothes ripping is maintained because the client likes the “feel” of ripping clothes? Would teaching the client to request a change of clothes decrease the clothes-ripping behavior? Probably not! In fact, this program might provide “more fuel to the fire!”

Privacy Please. A male client with mental retardation engages in masturbation out in a public, open area of a residential facility. Perhaps such behavior should be done behind closed doors! Teaching him to request privacy via a signal allows staff to mediate this request in the following manner. He is brought to his bedroom area where the door is closed. He is then free to engage in such behavior. Of course, he is not allowed to engage in public displays any more, and such attempts are immediately stopped by removal of the opportunity for a designated time. As the staff become excellent at thwarting his public attempts, requesting privacy becomes more attractive and functional. Exhibiting such a request provides unhindered access to genital stimulation. His behavior changes as a function of differential reinforcement. Public displays undergo extinction, while requests for privacy increase. Everyone is happy!

Delay of Gratification Training Option (Omission Training) Allowing a client free unrestricted access to the desired reinforcer, contingent upon a request, is certainly a good first strategy to use in many cases. Developing a mand for accessing a reinforcer is certainly more preferable than denying access to the reinforcer with concomitant side effect behaviors. Case in point: Obstructing the client’s access to the bathroom in the prior real-life example resulted in generating other more disastrous behaviors, while not solving the initial problem.

Cipani, E. P. (2017). Functional behavioral assessment, diagnosis, and treatment, third edition : a complete system for education and mental health settings. Retrieved from http://ebookcentral.proquest.com Created from snhu-ebooks on 2018-10-25 18:47:37.

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150 Functional Behavioral Assessment, Diagnosis, and Treatment

Therefore, teaching the client to mand (request) for a desired reinforcer should have the effect of removing problem behaviors whose function was to access the prohibited reinforcer. Unfortunately, in some circumstances, such a strategy as the replacement function option may run into trouble. Let us take a young girl in an educational program who frequently engages in stereotypic behavior of touching the floor five times each side with her left and then right hand. The teacher decides to develop a requesting option that allows her to sign “play.” Contingent upon signing “play” she is allowed to touch the floor in an area of the classroom designated for such behavior (to develop setting stimulus control).

Such a plan may not reduce the frequency of stereotypic behavior to a more acceptable level. Suppose the client requests permission to engage in stereotypic behavior every 2 minutes? She is requesting it so often it is to the point where the teacher cannot get her to complete any instructional task! What do you do then? Obviously, a client who frequently requests to engage in stereotypic behavior would pose a problem for most school or work environments. In many cases, developing requesting behaviors to access sensory or tangible reinforcement should also be combined with other replacement function options. Such an additional strategy should gradually reduce the level of accessing the reinforcer to a more manageable reasonable level. I have termed it, “weaning them off of frequent reinforcement.”

DISCUSSION QUESTION 4B Do you think most people expect a skill, such as the ability to delay immediate gratification, to develop naturally, without structured efforts on the part of care providers? Why is that a presumption?

One treatment option of choice for these circumstances is omission training (DRO) or what we term, delay of gratification training. In delay of gratification training, the client is taught to forgo engaging in the target behavior that is producing reinforcement for a designated amount of time. Fulfilling this requirement is the contingency for authorized access to the sensory or tangible reinforcer (Mazaleski, Iwata, Vollmer, Zarcone, & Smith, 1993). By beginning with a small amount of time, termed the DRO interval, the client learns to reliably delay gratification. Contingent upon success being obtained with the initial small DRO interval, the interval is gradually increased. Therefore, the client learns to forego the reinforcer for longer periods of time in a progressive manner. This develops greater self- control in regard to the client’s baseline level of access, in contrast to where she previously required more immediate gratification. Additionally, a chain interruption procedure is deployed contingent upon the behavior, with a restarting of the full DRO interval.

This replacement function option does not develop a specific replacement behavior, or even a systematic chain of behaviors. Hence, it is often not considered by many as a viable treatment option. However, it can be very fruitful in progressively increasing the length of time a client goes without “needing” access to the reinforcing event. The performance criterion for accessing the desired activity or item is the absence of the target behavior (which is not a behavior), or the occurrence of any other behavior(s).

However, such a strategy allows a behavior analyst to dissuade someone of their frequent access of a desired event. It accomplishes this goal by gradually increasing the DRO1 interval, which develops the ability of the individual to wait for longer periods of time before accessing the desired event. In the common parlance, such a phenomenon is called the “ability to delay gratification” (hence our use of the term, Delay of Gratification Training).

Talking Is Good When It Occurs in the Right Context! Remember the client with dis abilities who talked loudly to herself while pushing a laundry cart across a parking lot (see Chapter 3)? This behavior was hypothesized by me to produce its own auditory (hearing one’s voice) or kinesthetic stimulation (sensory effect on vocal cords). If a review of antecedent context data reveals that such vocal discourse occurs at a consistent rate during staff absence, what can be done to bring it under more acceptable conditions? When is vocal behavior acceptable? When you talk to other people! When is it OK to talk to oneself without raising suspicions that one is delusional? When it is done as a song!

Cipani, E. P. (2017). Functional behavioral assessment, diagnosis, and treatment, third edition : a complete system for education and mental health settings. Retrieved from http://ebookcentral.proquest.com Created from snhu-ebooks on 2018-10-25 18:47:37.

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