An Evaluation of Persistence of Treatment Effects During Long‐term Treatment of Destructive Behavior

Abstract

Eight young children who displayed destructive behavior maintained, at least in part, by negative reinforcement received long-term functional communication training (FCT). During FCT, the children completed a portion of a task and then touched a communication card attached to a microswitch to obtain brief breaks. Prior to and intermittently throughout FCT, extinction probes were conducted within a withdrawal design in which task completion, manding, and destructive behavior were placed on extinction to evaluate the relative persistence of appropriate and destructive behavior over the course of treatment. FCT continued until appropriate behavior persisted and destructive behavior failed to recur at baseline levels during extinction probes. The completion of FCT was followed by four challenges to the persistence of treatment effects conducted within mixed- or multiple-schedule designs: (a) extended extinction sessions (from 5 to 15 min), (b) introduction of a novel task, (c) removal of the microswitch and communication card, and (d) a mixed schedule of reinforcement in which both appropriate and destructive behavior produced reinforcement. The results showed that although FCT often resulted in quick reductions in destructive behavior and increases in appropriate behavior, destructive behavior often recurred during the extinction probes conducted during the initial treatment. When the effects of treatment persisted during the extinction probes, the remaining challenges to treatment effects resulted in only mild to moderate disruptions in behavior. These results are consistent with the quantitative predictions of behavioral momentum theory and may provide an alternative definition of maintenance as constituting behavioral persistence.

Effects of Response Effort on Resurgence

“…All participants engaged in the response paired with an increased response effort during extinction; interestingly, participants engaged in the increased response requirement (placing balls in a basket 1.829 m away) at lower rates during extinction when compared to participants exposed to a minimal response requirement (placing balls in a basket .9 m away). The findings of the current study are consistent with previous research on resurgence (e.g., Sweeney & Shahan, 2013;Wacker et al, 2013) and add to the growing research on mitigating rates of resurgence in clinical settings (e.g., Marsteller & St. Peter, 2014;Volkert et al, 2009). When taken together with the differentiation of rates of resurgence during periods of extinction, it would appear that response effort (rather than magnitude of reinforcement) diminished resurgence rates during phase III.…”

Telehealth and Autism: Treating Challenging Behavior at Lower Cost

“…Only children who completed FA and were started in FCT were included in the current analysis. Information on a subsample of children from group 1 was reported previously by Wacker et al 12 Wacker et al 5,11 reported selected data from 20 of the participants from group 2, and Suess et al 14 described treatment fidelity data from the first 3 participants in group 3. Among the 107 children who started FCT in these 3 groups, 8 discontinued treatment in group 1 (3 with ASD, 5 with other DD), 3 discontinued treatment in group 2, and 2 discontinued treatment in group 3.…”

“…Wacker et al 5 demonstrated that weekly coaching for parents can identify the social functions of problem behavior and replace these behaviors with alternative communication. [11][12][13] In the initial studies in this series, 12,13 behavior consultants traveled to family homes weekly to coach parents in conducting FA and FCT. The same strategies have subsequently been tested via telehealth, initially by having families travel to outpatient clinics near their homes 5, 11 and later by providing telehealth coaching to parents in their own homes.…”

An Evaluation of Lag Schedules of Reinforcement During Functional Communication Training: Effects on Varied Mand Responding and Challenging Behavior

“…Specifically, targeting varied mand responding during FCT may have utility in terms of the Implications for Practice • Extension of previous research on the use of FCT to treat challenging behavior exhibited by individuals with autism • Extension of previous research on the use of lag schedules to increase varied mand responding in individuals with autism • First investigation to evaluate the effects of combining lag schedules and FCT on varied mand usage during treatment of challenging behavior • Reinforcing mand variability may have utility in preventing or mitigiating clinical relapse of challenging behavior during challenges to treatment prevention or mitigation of clinical relapse (e.g., resurgence; Epstein, 1983). Wacker et al (2011) described several conditions that represent challenges to treatments that can result in the resurgence of challenging behavior including brief and/or prolonged periods of extinction of mands resulting from lapses in treatment fidelity. This effect has been demonstrated in several studies in which resurgence of challenging behavior occurred when extinction was applied to trained mands during FCT (e.g., Wacker et al, 2011).…”