The Influence of Antecedents and Consequences on the Occurrence of Bizarre Speech in Individuals With Dementia

Abstract

We conducted a series of assessments to determine the differential effects of common antecedents and consequences that can influence the occurrence of bizarre speech in three women with moderate to severe dementia. First, a traditional functional analysis was conducted to assess the function of bizarre speech. After results revealed differentially higher levels of bizarre speech during control sessions, an antecedent analysis was conducted. During this second assessment, all consequences were held constant, and only the antecedents (i.e., open-ended questions, yes/no questions, and comments) were altered. Bizarre speech was differentially higher when open-ended questions were presented, replicating previous studies. The final assessment conducted was a modified functional analysis to further assess the effects of consequences on bizarre speech. More typical consequences were assessed, including two tests for a positive function (attention in the form of correction and attention in the form of following along) and two tests for a negative function (a break from one question and a break from all questions). Results consistently revealed that antecedents produced greater differentiation in responding than social consequences. These findings provide evidence that behavioral assessments may need to be modified to better capture the relevant environmental variables that influence problem behavior in individuals with dementia.

Descriptive assessment of inappropriate vocalizations emitted by persons diagnosed with dementia

“…It is possible that engaging with materials (often reading materials) may have competed with vocalizations. Trahan et al () demonstrated that antecedent events were more likely to differentially influence the occurrence of disruptive vocalizations in this population relative to consequences. Future researchers could examine the extent to which treatment planning based on the results of the descriptive assessment (i.e., removing antecedent events that are likely to evoke the target behavior) improves treatment outcomes when functional analyses are not feasible.…”

“…For example, Kodak, Northup, and Kelley () demonstrated that different forms of attention (e.g., reprimands and unrelated comments) produced differential responding for two children with developmental disabilities whose functional analysis results suggested that attention was a reinforcer for their problem behavior. Although the results of Trahan et al () showed undifferentiated responding across consequent manipulations, those results may have been confounded with antecedent manipulations that resulted in high rates of inappropriate speech (i.e., open‐ended questions). Future researchers could further evaluate the influence of consequent events in this context by evaluating consequences identified by way of a DA in the absence of strong antecedent control.…”

“…Beaton et al () and Trahan et al () suggested that social interactions (i.e., attention) could be discriminative stimuli that may evoke both appropriate and inappropriate speech (Trahan et al, ). The results of our study showed that in some cases (e.g., Charlie's compliments and Janine's vocalizations), social interaction may occasion inappropriate vocalizations, which may reflect an individual's attempt to continue the interaction by using a verbal repertoire reduced due to the disease process.…”

“…Trahan, Donaldson, McNabney, and Kahng () evaluated the differential impact of antecedents and consequences on bizarre speech emitted by three adults with dementia. Following inconclusive FAs during which bizarre speech was highest in the control condition, Trahan et al () found that manipulating certain antecedents (i.e., the presentation of open‐ended vs. yes‐no questions) produced differentiated FA outcomes, whereas modifying social consequences did not. These results corroborate the findings of Beaton et al (), which suggested that social interaction may occasion disruptive vocalizations.…”

Cognition and language in dementia patients: Contributions from behavior analysis

“…Of the nine studies on verbal behavior in dementia patients, four investigated verbal operants (Gross, Fuqua, & Merritt, ; Henry & Horne, ; Oleson & Baker, ; Trahan, Donaldson, McNabney, & Kahng, ). Other studies related to verbal behavior focused on disruptive vocalizations (Beaton, Peeler, & Harvey, ; Buchanan & Fisher, ; Locke & Mudford, and Trahan, Donaldson, McNabney, & Kahng, ).…”