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Practical Functional Assessment and Skill-Based Treatment of Problem Behavior
This article originally appeared in START Connecting in November 2019.
The work of Gregory Hanley, Ph.D., BCBA-D and his colleagues at FTF Behavior Consulting is dedicated to disseminating safe and efficient functional assessment procedures that inform highly effective and humane treatments for problem behavior of persons with autism and intellectual disabilities (ID).
The Main Points
- Severe problem behavior (e.g., self-injury, aggression, property destruction) is prevalent among persons with autism.
- Severe problem behavior persists, in large part, because it produces personally relevant outcomes (reinforcers) for the person who exhibits it.
- All children with autism and their families are capable of living a life free from severe problem behavior.
- Freedom from problem behavior is possible and probable when the skills of communication, toleration, and a range of contextually appropriate behaviors are taught in a context in which problem behavior was shown to occur and then generalized to additional contexts and to relevant people and places.
- A practical functional assessment (PFA) is used to inform a skill-based treatment (SBT). A PFA involves an interview and then a brief analysis. This occurs in one or two visits. The priorities in a PFA process are safety, dignity, and rapport building; an understanding of why problem behavior is occurring follows.
- The first PFA step is to gather information via interview about the personally relevant outcomes and the situations in which the different problem behaviors are typically evoked.
- The second PFA step is to design, and have the child/client experience, a context in which the personally relevant reinforcers are freely and continuously available; this is done to establish trust, build rapport, and to ensure that zero levels of problem behavior and high levels of engagement are achievable.
- Once it is evident that the child/client is happy, relaxed, and engaged, the third PFA step is to introduce an evocative situation (e.g., progressively removing the personally relevant reinforcers), and then immediately provide access to all reinforcers following the initial instance of a problem behavior or an observable indicator that problem behavior is imminent. This step, which is sometimes iterative, allows the team to confirm that (a) a personally relevant and motivating context was successfully designed and (b) they can safely turn off problem behavior once it starts to occur.
- By repeating these interactions, the child/client learns that they are effective in this context without escalated problem behavior while the team learns that they have a safe and properly motivating context in which to teach skills.
- The skill-based treatment (SBT) process follows directly from the PFA.
- SBT processes start by consistently providing access to all the personally relevant reinforcers following simple communication responses. A somewhat errorless process then ensues to stretch the number and developmental appropriateness of responses while teaching the child/client what to do when they cannot have their way.
- The skills of communication, toleration, and a range of contextually appropriate behaviors (CABs) are progressively developed through repeated practice sessions in the same context that was shown to be sufficiently safe and motivating in the PFA. Common CAB chains include relinquishing reinforcers, transitioning to and completing academic work, playing independently, completing hygiene activities and chores, or holding a multi-topic conversation.
The skills persist because they are reinforced on an unpredictable and intermittent schedule, the same schedule that presumably resulted in their repertoire of problem behavior. By providing immediate access to personally relevant reinforcers for all important behaviors some of the time, these important behaviors maintain while children/clients learn how to behave effectively despite ambiguity, delay, and disappointment. In other words, trust in relationships is retained and hope is fostered as challenging expectations are reintroduced in this process.
Development and eventual description of the PFA and SBT processes can be found in these articles and book chapters co-authored by Dr. Hanley:
Hanley, G. P., Piazza, C. C. et al. (1997). Evaluation of client preference for function-based treatments. JABA, 30, 459-473.
Piazza, C. C., Hanley, G. P. et al. (1998). On the establishing and reinforcing effects of termination of demands for destructive behavior maintained by positive and negative reinforcement. RIDD, 19, 395-407.
Hanley, G. P., Iwata, B. A. et al. (2000). A component analysis of “using stereotypy as reinforcement” for alternative behavior. JABA, 33, 285-297.
Hanley, G. P., Iwata, B. A. et al. (2003). Functional analysis of problem behavior: A review. JABA, 36, 147-186.
Hanley G. P., Heal, N. A. et al. (2007). Evaluation of a classwide teaching program for developing preschool life skills. JABA, 40, 277-300.
Tiger, J. H., Hanley, G. P. et al. (2008). Functional communication training: A review and practical guide. BAP, 1, 16-23.
Heal, N. A., Hanley, G. P. et al. (2009). An evaluation of the relative efficacy of and child preference for teaching strategies that differ in amount of teacher directedness. JABA, 42, 123-143.
Hanley, G. P. (2010). Identifying effective and preferred behavior-change programs: A case for the objective measurement of social validity. BAP, 3, 13-21.
Luczynski, K. C., & Hanley, G. P. (2009). Do young children prefer contingencies? An evaluation of preschooler’s preference for contingent versus noncontingent social reinforcement. JABA, 42, 511-525.
Hanley, G. P. (2010). Prevention and treatment of severe problem behavior. In E. Mayville & J. Mulick (Eds.) Behavioral foundations of autism intervention. Sloan Publishing: New York.
Hanley, G. P. (2011). Functional analysis. In J. Luiselli (Ed.) Teaching and Behavior Support for Children and Adults with Autism Spectrum Disorder: A “How to” Practitioner’s Guide. Oxford University Press: New York.
Heal, N. A., & Hanley, G. P. (2011). Embedded prompting may function as embedded punishment: Detection of unexpected behavioral processes within a typical preschool teaching strategy. JABA, 44, 127-131.
Hanley, G. P. (2012). Functional assessment of problem behavior: Dispelling myths, overcoming implementation obstacles, and developing new lore. BAP, 5, 54-72.
Luczynski, K. C. & Hanley, G. P. (2013). Preventing the development of problem behavior by teaching functional communication and self-control skills to preschoolers. JABA, 46, 355-368.
Potter, J. N., Hanley, G. P. et al. (2013). Treating stereotypy in adolescents diagnosed with autism by refining the tactic of “using stereotypy as reinforcement” JABA, 46, 407-423.
Hanley, G. P., Jin, C. S. et al. (2014). Producing meaningful improvements in problem behavior of children with autism via synthesized analyses and treatments. JABA, 47, 16-36.
Luczynski, K. C., Hanley, G. P. et al. (2014). An evaluation of the generalization and maintenance of functional communication and self-control skills with preschoolers. JABA, 47, 246-263.
Hanley, G. P., Fahmie, T. et al. (2014). Evaluation of the preschool life skills curriculum in Head Start classrooms: A systematic replication. JABA, 47, 443-448.
Luczynski, K. C., & Hanley, G. P. (2014). How should periods without social interaction be scheduled? Child preference for and the efficacy of practical schedules of positive reinforcement. JABA, 47, 500-522.
Ghaemmaghami, M., Hanley, G. P. et al. (2015) Affirming control by multiple reinforcers via progressive treatment analysis. Beh. Interventions, 31, 70-86.
Santiago, J. L., Hanley, G. P. et al. (2016). The generality of interview-informed analyses: Systematic replications in school & home. JADD, 46, 797-811.
Jessel, J., Hanley, G. P. et al. (2016). Interview-informed synthesized contingency analyses: Thirty replications and reanalysis. JABA, 49, 576–595.
Ghaemmaghami, M., Hanley, G. P. et al. (2016). Contingencies promote delay tolerance. JABA, 49, 548-575
Slaton, J. D. & Hanley, G. P. (2016). Effects of multiple versus chained schedules on stereotypy and functional engagement. JABA, 49, 927–946.
Madden, G. J., Hanley, G. P., & Dougher, M. J., (2016). Clinical behavior analysis: A new approach to language, meaning and therapy. In J. Norcross et al. (Eds.), APA Handbook of Clinical Psychology, Am. Psych. Assoc.: Washington D. C.
Slaton, J. D., Hanley, G. P. et al. (2017). Interview-informed functional analyses: A comparison of synthesized and isolated components. JABA, 50, 252–277.
Ghaemmaghami, M., Hanley, G. P. et al. (2018). Shaping complex functional communication responses. JABA, 51, 502-520.
Slaton, J. D. & Hanley, G. P. (2018). Nature and scope of synthesis in functional analysis and treatment of problem behavior. JABA, 51, 943-973.
Rajaraman, A. & Hanley, G. P. (2018). Interview-informed synthesized contingency analysis (IISCA). In: Volkmar, F. (Eds.) Encyclopedia of Autism Spectrum Disorders. Springer, New York, NY.
Jessel, J., Hanley, G. P. et al. (2019). An evaluation of the single-session interview-informed synthesized contingency analysis. Beh. Interventions, 34, 62-78.
Jessel, J., Metras, R. et al. (2019). Evaluating the boundaries of analytic efficiency and control: A consecutive controlled case series of 26 functional analyses. JABA.
Slaton, J. & Hanley, G. (2019). Practical functional assessment of problem behavior. In R. Pennington (Ed.) Principles and practices explained by researchers who use them. Autism Asperger Publishing Company.
Warner, C. A., Hanley, G. P. et al. (2019). An evaluation of progressive extinction to assess response class membership of multiple topographies of problem behavior. JABA.
Systematic replications of PFA and treatment from other research groups:
Strand, R. C. W., & Eldevik, S. (2016). Improvements in problem behavior in a child with autism spectrum diagnosis through synthesized analysis and treatment: A replication in an EIBI home program. Beh. Interventions, 33, 102–111.
Strohmeier, C. W., Murphy, A. et al. (2016). Parent-informed test-control functional analysis and treatment of problem behavior related to combined establishing operations. Dev. Neurorehabilitation, 20, 247-252.
Lambert, J. M., Staubitz, J. E., et al. (2017). Outcome summaries of latency-based functional analyses conducted in hospital inpatient units. JABA, 50, 487-494.
Jessel, J., Ingvarsson, E. T. et al. (2018). Achieving socially significant reductions in problem behavior following the interview-informed synthesized contingency analysis: A summary of 25 outpatient applications. JABA, 51, 130–157.
Herman, C., Healy, O. et al. (2018). An interview-informed synthesized contingency analysis to inform the treatment of challenging behavior in a young child with autism. Dev. Neurorehabilitation, 21, 202–207.
Taylor, S. A., Phillips, K. J. et al. (2018). Use of synthesized analysis and informed treatment to promote school reintegration. Beh. Interventions, 33, 1-16.
Beaulieu, L., Van Nostrand, M.E. et al. (2018). Incorporating interview-informed functional analyses into practice. BAP, 11, 385-389.
Rose, J. & Beaulieu, L. (2018) Assessing the generality and durability of interview-informed functional analyses and treatment. JABA, 52, 271-285.
Ferguson, J. L., Leaf, J. A. et al. (2019). Practical functional assessment: A case study replication and extension with a child diagnosed with autism spectrum disorder. ETC.
Coffey, A., Shawler, L. et al. (2019). Interview-Informed Synthesized Contingency Analysis (IISCA): Novel interpretations & future directions, BAP, 12, 1-9.