3 part pres (ho) 5 23 17 - · pdf file03.05.2016 · 5/23/2017 1 gregory p. hanley...

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GregoryP.HanleyPh.D.,BCBA‐D

FunctionalAssessmentofSevereProblemBehaviorofPersonswithAutism:

AFocusonaSafer,Faster,andStillEffectiveProcess

Formoreinformationgoto:www.practicalfunctionalassessment.com

WorkshopforDetroitWayneMentalHealthAuthority June,2017

Whydo“lifestyles”dictatedbyproblembehaviorpersistforfamiliesofchildrenwithautism?

Wholeshavepropertiesnotpresentintheparts

andnotreducibletothestudyoftheparts

MightwebenefitfromatouchofHolism?

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Bewaryofincontrovertibletruths.

“Allmodelsarewrong;someareuseful.”

Box &Draper,1987,p.424

Functionalassessment

process todeterminethevariablesinfluencingproblem

behavior

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SomeAssumptions

Problembehaviorisanoperant

Certainsituationspotentiatecertainconsequences

GoalofaFunctionalAssessmentIdentifytheconsequencesthatmaintainproblembehavior

Identifythesituationsthatevokethebehavior

Inordertotreatproblembehavior

FunctionalAssessmentProcess

FunctionalAnalysisObservewhilemanipulating

IndirectAssessmentInterview

DescriptiveAssessmentObserve

Discovery Demonstrationand

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DefiningfeaturesoftheStandardFunctionalAnalysis

Multiple test conditions

Uniform test conditions

Isolated test contingencies

Reinforce dangerous behavior only

Toy-play control condition

Problem Behavior

Per M

inute

Sessions

Exampleofastandardfunctionalanalysis

Howdoweknowthisisthestandardfunctionalanalysis?

(Jessel,Hanley,Ghaemmaghami,2016)

1965‐2000(Hanleyetal.,2003)

64%SFAs1out3withmodifications

2001‐2012(Beaversetal.,2014)

85%SFAs1outof7withmodifications






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IstheStandardFunctionalAnalysisEffective?

Doesitleadtoadifferentiatedanalysis?

Literaturereviews:Hanleyetal.(2003): 94%Beaversetal.(2014): 92%

Caseseries:Hagopianetal.(2014): 47%Slatonetal.(2016): 44%


Doesitleadstolargertreatmenteffects?

Campbell(2003)HigherPZDwhenRxwasbasedon“EFA”

But,theselargereffectswerealmostexclusivelyobtainedwhenresearchersimplementedthetreatmentsincontrolledsettingsunderrichschedulesofreinforcement


Notonestudyshowingasocially‐validatedoutcomeinarelevantsettingwhenimplementedbyarelevantperson

whenastandardfunctionalanalysiswasused

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Apparentsolutiontoineffectiveness:Excessiveelaboration

Elaborationofthestandardfunctionalanalysis(SFA)

PriortoaSFAFormaldescriptiveassessments

PreferenceanalysesDemandanalyses

PrecursoranalysesManualsoutliningextensiveteam‐basedprocesses

FollowingafailedSFAManyslightandsystematicdeviationsfromtheSFAcoreprocedures

FollowingafailedSFA‐basedtreatmentStimulusavoidanceanalyses

Morepreferenceanalysisandreinforcer analysis

DespitetheExcessiveElaborationoftheStandardFunctionalAnalysis…

Notonestudyshowing…

…apracticaloutcomeinarelevantcontext

…thesocialacceptabilityoftheprocess

…asocially‐validatedeffectonproblembehavior

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“Sinceallmodelsarewrong,thescientistcannotobtaina‘correct’onebyexcessiveelaboration.

Justastheabilitytodevisesimplebutevocativemodelsisthesignatureofgreatsciencesooverelaborationisoftenthemarkofmediocrity.”

GeorgeBox,1976,p.792

ResearchtopracticegapPossiblereason:

Becausetheoutcomesaremediocre

evenwhentheprocessiselaborate

Functionalanalysishasbeenaroundforapprox.50years(e.g.,Lovaas etal.,1965;Sailoretal.,1968)

Standardfunctionalanalyseshavebeenaround34years(Iwataetal.,1982)

Over300studiescontainingover500standardfunctionalanalyseshavebeenpublished(Jesseletal.,2016)

Yet,55to65%ofpractitionersrecentlysurveyedreportedneverconductingafunctionalanalysis(Oliveretal.,2016;Roscoeetal.,2015)

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Interview-informed Synthesized Contingency

Analysis

IISCA

StandardFunctionalAnalysisMultiple test conditions



Reinforce dangerous behavior


Interview-Informed Synthesized Contingency AnalysisSingle-test condition

Individualized test conditions

Synthesized contingencies

Reinforce precursors to and dangerous behavior

Test-matched control

Sessions

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AnIISCA

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SomeImportantAspectsofourApproach

Closed‐endedindirectassessments(MAS,QABF,FAST)areneverusedintheprocessbecausetheydonotprovideanyinformationaboutpersonallyuniqueorqualitativefeaturesofpotentiallyinfluentialvariables

Anopen‐endedinterviewisalwayspartoftheprocess

Primarygoalsaretoidentify:

a) co‐occurringtopographiesofproblembehaviorb) events/interactionsthatappeartoroutinelyevokeproblembehavior

c) interactionsthatfollowproblembehaviorandarereportedtostopit

Interviewsallowfordiscoverieswhichcanthenbeverified(ornot)intheIISCA

SomeImportantAspectsoftheIISCA

Extensivedescriptiveassessmentsareneverpartoftheprocess

becausetheyare:time‐consuming

andusuallysuggestinvalidrelationsSt.Peteretal.,2005;Thompson&Iwata,2007


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Wesynthesize multiplecontingenciesintoonetestconditionwhichcontingenciesandthespecificmaterialsandinteractionsareinformedbytheinterview


Whymightproblembehavioroccur?Singlecontingencies:1. Attentionortoys(social‐positivereinforcement)2. Escape/avoidance(social‐negativereinforcement)3. Sensory/non‐social(automaticreinforcement)

Combinatorialcontingencies:1. Attentionand Toys2. Escapeto toys3. Escapeto toysandattention4. Escapeto automaticreinforcement5. Compliancewithmands6. Escapetoaccesstorituals,preferredconversations7. Etc…..

CaseExample(Bob,8yo,dx:Autism)Analyst:SandyJinSetting:Clinic

Inextricablesynthesis

Hypothesis:

Bobengagesinmeltdownsandaggressioninordertoobtain:

“Hisway”intheformofescapefromadultinstructionsandaccesstopreferredwaysofinteractingwithelectronicsoracademicmaterials

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Escape /Tangible

Escape /Tangible

Bob(Ipad context)

Bob(Math context)

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CaseExample(Dale,11yo,dx:Autism)Therapist:SandyJinSetting:Clinic

Hypothesis:

Daleengagesinmeltdownsandaggressioninordertoobtain:

“Hisway”intheformofescapefromadultinstructionsandaccesstopreferred(tangible)items,andadultattention.

Pro

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Analyst

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TeCoTeCo

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Escape /Tangible /Attention /Mand complianc

Electivesynthesis(withinitialverification)

Hypotheses:

Gailengagesinmeltdownsandaggressioninordertoobtain:

preferred(tangible)itemsandmaternalattention

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Tangible /Attention

AnalystMother

AnalystMother

Analyst

Gail

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Meltdowns Col 46

Attention

CaseExample(Gail,3yo,dx:PDD‐NOS)Analyst:NicholasVanselowSetting:Clinic

Whysynthesize?

1. Seemstoemulatetheecologybetter

2. Isolatedcontingenciessometimesdonotcontrolbehaviorwhereassynthesizedcontingenciesdo.

• Calletal.,2005• Dolezal & Kurtz,2010• Hanleyetal.,2014• Ghaemmaghamietal.,2016• Muelleretal.,2005• Slatonetal.,2016• Slatonetal.,2016

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www.practicalfunctionalassessment.com

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8TestControl

Food,attention

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AttentionTangible (food)Control

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Jay

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AttentionTangibleEscape

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Franklin

EscapeRequestsControl

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IISCA Decoupled IISCASynthesized Isolated SynthesizedType of

contingency

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Slatonetal.,2016

Whysynthesize?

1. Seemstoemulatetheecologybetter

2. Isolatedcontingenciessometimesdonotcontrolbehaviorwhereassynthesizedcontingenciesdo

3. Doingsoleadstoeffectiveaction—meaningfultreatmenteffects

– Hanleyetal.,2014,Santiagoetal.,2016;Ghaemmaghamietal.,2016

Somereasonablequestions:

HaveIISCAsbeenreplicated?(I.e.,Dotheyhavegenerality?)

Yes.

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FromJessel,Hanley,and

Ghaemmaghami(JABA,2016)

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12 Will

TestControl

Wayne Allen Kat (Cxt 1)Sam

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Kristy Jim

Roxy

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Jeff Zeke Kat (Cxt 2)

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Gary Jian Earl

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1.0

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Paul Dan

Alex (Cxt 1) Beck

Sid

2 6 10

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1.0

1.5

2.0

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Lee

2 4 6

Steve

1 3 5

Jesse

1 3 5

Carson

1 3 5

Jack (Cxt 2)

Sessions

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FromRajaramanetal.(2016)

Hastheprocessbeensociallyvalidated?Yes.

Social Acceptability Questionnaire Results

Ratings

Questions Gail Dale Bob Mean

1. Acceptability of assessment procedures 7 7 7 7

2. Acceptability of treatment packages 7 7 7 7

3. Satisfaction with improvement in problem behavior 7 7 6 6.7

4. Helpfulness of consultation 7 7 7 7

Note. 7=highly acceptable, highly satisfied, or very helpful 1=not acceptable, not satisfied, or not helpful

fromHanleyetal.,JABA,2014

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Hastheprocessbeensociallyvalidated?Yes.

fromSantiagoetal.,JADD,2016

HavesociallyvalidatedtreatmentsbeendevelopedfromtheIISCA?

HavesociallyvalidatedeffectsbeenachievedfromtheIISCA?


Ratings







fromHanleyetal.,JABA,2014

Sociallyvalidatedtreatmentsandoutcomes.Yes.

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Sociallyvalidatedtreatmentsandoutcomes.Yes.


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ComplianceNoncomp.

Levels3

BL FCT + EXT Denial and Delay Tolerance TrainingSimple FCR Complex FCR

Zeke

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Response Chaining


Treatment:

Unpredictableandintermittentreinforcementof

communication,toleration,andcompliance

Implementedbyrelevantcaregiversinrelevantcontextswhoimposerelevantandhistoricallychallengingroutines

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BeonthelookoutinJABA forthisstudybyDr.JoshuaJessel&colleagues:

AchievingSociallySignificantReductionsinProblemBehaviorfollowingtheInterview‐InformedSynthesizedContingencyAnalysis:

ASummaryof25OutpatientApplications

Baseline Treatment0

2

4

6

N = 25

p < .001

Pro

blem

beh

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You found the recommended treatment acceptable

You are satisfied with the amount ofimprovement seen in problem behavior

You are satisfied with the amountof improvement seen in

communication skills

You found the assessment andtreatment helpful to your home situation

Notacceptable/satisfied/helpful

Highlyacceptable/

satisfied/helpfulCaregiver Rating

But,didn’tDr.FisherjustpublishanarticleinJABAshowingtheIISCA’swerealwaysincorrect?

ComparisonsofsynthesizedandindividualreinforcementcontingenciesduringfunctionalanalysisWayneW.Fisher,BrianD.Greer,PatrickW.Romani,&AmandaN.Zangrillo2016

FromFisheretal.,2016DifferentiationSFA:4of5IISCA:4of5

Escape to Tangibles & Attention

Escape / Tangible

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Irrelevanceofacontingencyishardtoprove.

Genericfunctionscanbeeasilymoderatedinanalyses.(seeHanley,Piazza,&Fisher,JABA,1997)

Therearenopuretestsofcontrolbysinglereinforcers,especiallytangibles.

Thetruthcanbefoundin

effectiveaction‐Differentiatedanalysis‐Efficiencyofandcontrolinanalysis‐Meaningfultreatmenteffects

Slaton,J.,Hanley,G.,&Raftery,K.(2016)

IISCAvs.StandardAnalysis

0

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2TestControl

Escape to tangiblesand attention

Tangible

Ignore/Alone

PlayEscape

Attention

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3Escape to tangiblesand attention

1 2 3 4 50

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3Escape totangibles

5 10 15

Diego

Mason

Riley

Pro

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beh

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Sessions

IISCA Standard IISCA

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IISCAvs.StandardAnalysis

0

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2

Escape topredictableschedule

ControlTest

EscapePlay

AttentionTangible

Alone

1 2 3 4 5

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2Escape to tangibles,stereotypy, andattention

5 10 15 20 250

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d

Prob

lem

beh

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Jonah

IISCA Standard

Sessions

IISCAvs.StandardAnalysisIgnore/Alone

EscapeTangible

Play

Attention

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0

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2 4 60

1 Escape to tangibles

5 10 15 20

Pro

blem

beh

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Sessions

IISCA Standard

Dylan

Emily

Chloe

Jeff

0

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ControlTest

Escape totangibles

TreatmentComparisonResults

5 10 15 20 25

0

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Escape torituals

BL FCT + EXT

5 10 15 20 25

EscapeBL FCT + EXT

0

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Escape

Tangibles

IISCA- based treatment Standard-based treatment

Pro

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Chloe

Dylan

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TreatmentComparisonResults

0

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FCR

BL FCT + EXTEscape totangibles,attention

Problembehavior

BL FCT + EXTEscape

5 100

1

Escape totangibles

BL FCT + EXT

5 10

Attention

BL FCT + EXT

IISCA- based treatment Standard-based treatment

Pro

blem

beh

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Sessions

Emily

Jeff

Thesupposedproblem(s)withtheIISCAImprecision Donotknowthespecificoperantclasstowhichanyparticulartopographyofproblembehaviorbelongs.

Donotknowwhethersomepart(s)ofthesynthesizedcontingencyareirrelevant

Donotknowwhetherbehaviorismaintainedbypos orneg sr Sometimescannotneatlydescribeorcompartmentalizethecontrollingvariables

Considertheeffectiveactionwithoutknowingthesethings

ImprecisionisnotUniquetotheIISCAInterpretiveambiguityfromanIISCA

PartlysynthesizedcontingenciespopulateSFAsInterpretiveambiguityfromanSFA

ThesupposedprecisionofaSFAisanillusion

Antecedent PB Consequence Interpretation

NoAttention/Notangible NoAttention/Tangible Might beevokedbylowattn.orlackoftangible,orbothandmaintainedbyattn.ortangorboth

Attention/Notangible Attention /Tangible Might bemaintainedbytangibleorattentionorboth

Antecedent PB Consequence Interpretation

NoAttention/Notangible Attention /Tangible Behaviormaybecontrolledbyone,theother,orboth

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“Allmodelsarewrong;thepracticalquestionis

howwrongdotheyhavetobetonotbeuseful.”

Box &Draper,1987,p.424

RecognizetheHistoricalSignificanceoftheStandardFunctionalAnalysis

• Movedusfrombehaviormodificationtobehavioranalysis– Taughtusourprofessionalhumility

• Inspiredustotranscenddescriptionandpredictiontocontrol– Allowedustobescientificpractitioners

• Showedushowtocreatestableandcontrolledbaselines– Allowedustodiscoverandenhancetreatments






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Toachievethehumanepromiseofafunction‐basedtreatmentandasociallyvalidoutcome

Fromafunctionalanalysis:

WhatmustIknow?WhatcanIsafelyinfer?WhatdoInotneedtoknow?

ThatwhichImustknowviamyfunctionalanalysis:

ThatIcanreliablyturnproblembehavioroffwiththepresentationofthereinforcers

ThatIcanreliablyturnproblembehavioronwiththepresentationoftheevocativeevents

Andthatthereinforcersandevocativeeventswereidentifiedbyotherpeoplerelevanttothebehaver

ThatwhichIcansafelyinferviamyfunctionalanalysis:

Responseclassmembership

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ProblemBehaviorsreportedtoco‐occur(inorderofconcern)1. SIB2. Aggression3. DisruptiveBehavior4. Disruptivevocalizations

5. Whining/complaining

Thisanalysisshowsallformsofproblembehaviorareevokedandmaintainedbysamesynthesizedcontingency.

Thishappenseverytimeweconductthissortofanalysis.(Warneretal.,2016)

Thishappenseverytimeanybodyelseconductthissortofanalysis(SmithandChurchill,2002,Borrero&Borrero,2008,Herscovitch etal.,2009)

ThatwhichIcansafelyinferviamyfunctionalanalysis:

Responseclassmembership

Reportedco‐occurrence=maintainedbysamereinforcers

Iwillinferresponseclassmembershipandusetheirresponsetointervention(RTI)asverification

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ThatwhichIdonotneedtoknowviamyfunctionalanalysis:

ThesingleoperantfunctionofeachproblembehaviorWhetherproblembehaviorismaintainedbypositiveornegativereinforcementWhethersomeelementofasynthesizedcontingencyisa“true”contingencyormerelya“falsepositive”WhetherIcanneatlycompartmentalizetheoperationintheanalysisintoatidygenericclassofreinforcement

(e.g.,socialpositive,socialnegative,attn,tang,esc,etc.)

TheoriginalgoldstandardGeneralandsociallyvalidatedbehaviorchange

byrelevantpeopleinrelevantcontextsBaer,Wolf,&Risley,1968

Iachieveit:bybeingabletoturnonandoffproblem

behaviorinananalysisinformedbycaregivers

IachieveitwithanIISCA


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Comeupwithatleastonequestionrelevanttoconductingthefunctionalassessmentprocess.

• Whyisitimportanttoconductafunctionalassessmentwithafunctionalanalysisaspartoftheprocesspriortotreatingsevereproblembehavior?a. becausethefunctionalassessment

processishumaneanddignifyingb. becausebehaviormodificationis

ineffectivec. becauseresearchreviewsshowthatmore

effectivetreatmentsresultfromfunctionalassessmentprocesses,especiallythosethatcontainafunctionalanalysis

• Identifythefunctionalassessmenttoolsthatcanbeomittedfromaneffectivefunctionalassessmentprocessofsevereproblembehavior.a. closedendedindirectassessmentandfunctionalanalysis

b. open‐endedindirectassessmentandformaldescriptiveassessment

c. closed‐endedindirectassessmentsandformaldescriptiveassessments

d. open‐endedindirectassessmentandfunctionalanalysis

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• Whataretheessentialcomponentsofafunctionalanalysisofproblembehavior?a. directobservationofproblembehaviorduring

least4rapidlyalternatingconditions(demand,attention,alone,andtoyplay)

b. directobservationofproblembehaviorinaconditioncontainingthereinforcingcontingencythoughttomaintainsevereproblembehaviorandoneconditioninwhichthiscontingencyisabsent

c. indirectobservationofproblembehaviorduringseveraltestconditionsandatoyplaycontrolcondition

d. directobservationofproblembehaviorinthenaturalenvironment

• Nominatetheessentialfeaturesofaninterviewinformedsynthesizedcontingencyanalysis(IISCA)a. Test‐matchedcontrolconditionb. Interview‐informedsynthesized

contingencyc. Singleandindividualizedtestconditiond. Reinforcementprogrammedfor

precursorstoanddangerousbehavior

• Whatdoesaninformedanalysisprovidethebehavioranalyticpractitioner?

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• Whatdoesaninformedanalysisprovidethebehavioranalyticpractitioner?a. ademonstrationofproblembehavior

sensitivitytoasuspectedreinforcementcontingency

b. thetruthregardingthevariablescontrollingproblembehavior

c. astableandsensitivebaselinefromwhichtoevaluatetreatment

d. aproperlymotivatingsetofconditionstoteachfunctionalcommunicationanddelaytolerance

Whydotheanalysisiftheinterviewresultsseemstoclearlyindicateaparticularfunction?

TakeHomePoint

Priortotreatingproblembehaviorofchildrenwithautism

1. Conductanopenendedinterviewtodiscoverthecontextandoutcomesthatseemrelevanttoproblembehavior

2. ConductanIISCA todemonstratethevalidityofthesuspectedcontingency

– andtohaveaccesstotheproperlymotivatingconditionstoteachskills

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Let’sroleplaysomefunctionalanalyses.

Hand‐tohead‐SIBandgroaningappeartobemaintainedby:

1. Tangibles

2. Escapefromdemandstoaccesstangibles

3. Escapefromdemandstoaccesstangibles,attention,andstereotypy

4. Compliancewiththechild’smands(Escapefromtheteacher’swaytoaccessthechild’sway)

Let’sdesignanalysesfromtheinterviewresults

Sometips:1. Donotputresponsesincontingencyclassthatarelikelytobe

maintainedbyautomaticsr.2. Doconsiderputtingsomeill‐formedmands (e.g.,protests)in

thecontingencyclassifseverityofpb isoutrageous.3. IncorporatethemostchallengingandconvenientEOs. UsechallengingandinconvenientEOsastestsoftreatmentgenerality

4. Conductanalysiswhereyouhavethemostcontrolandwillbeableteachtheskills.

5. Erronthesideofsynthesizingtoomanycontingenciesratherthantoofew.

TreatingSevereProblemBehavior:AFocusonStrengtheningSociallyImportantBehaviorofPersonswithAutismGregoryP.HanleyPh.D.,BCBA‐D



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FunctionalAssessmentandTreatmentModel

Steps(expanded)

1 Interview

2 FunctionalAnalysis

3 SimpleFunctionalCommunicationTraining

4 ComplexFCT

5 ToleranceResponseTraining

6 EasyResponseChaining

7 DifficultResponseChaining

8 TreatmentExtension

IISCA‐BasedTreatment

• Processhasledtocomprehensivetreatmentswithlarge,generalizedeffects

• Treatmentreliesonstrengthening:functionalcommunicationdelay/denialtolerationcompliance

With

Intermittent&unpredictablereinforcement

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Problembehaviornolongeryieldsthereinforcers (escapetochild‐directedplayandteacherattention)

Asimpleresponse(buttonpress:“Mywayplease”)ispromptedandreinforcedwith(escapetochild‐directedplay&teacherattention)

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Amoreinteractionalresponse(shouldertap,waitforteacheracknowledgement,two‐buttonpress:MayIhave/Mywayplease”)ispromptedandreinforced

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Responsestodisappointmentarepromptedandreinforced:(Takeabreathandnoddingyes)

Now,FCRsarereinforcedhalfthetime.Theotherhalf,theteacherdeniesthebid(e.g.,says’s no,doyourworkwithoutme,please)

Cuesofdisappointment,Delaystoreinforcement,andunpredictableoutcomeshavenowbeenintroduced!

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Treatment Extension

1 2

Compliance

Noncomp.

Levels3


Zeke

Sim

ple

FCR

per

min

Tol

eran

ce R

espo

nse

per

min

Response Chaining

Now,FCRsarereinforced1/3ofthetime.

TRsarereinforced1/3ofthetime.

Andcompliancewithprogressivelylongerandmorechallenginginstructionsisreinforced

5/23/2017

30

0

1

2

3

4

0

1

2

3

4

Com

plex

FC

Rpe

r m

in

0

1

2

3

4

Reinforcem

ent (%)0

20

40

60

80

100

Pro

blem

Beh

avio

rpe

r m

in

0

1

2

3

4

Sessions

5 10 15 20 25 30 35 40 45 50 55 60 65

Res

pons

e to

In

stru

ctio

ns (

%)

0

20

40

60

80

100

Treatment Extension

1 2

Compliance

Noncomp.

Levels3


Zeke

Sim

ple

FCR

per

min

Tol

eran

ce R

espo

nse

per

min

Response Chaining

Whatisthetreatment????

Intermittentandunpredictablereinforcementoflifeskills:FunctionalCommunicationDelay/denialtolerationCompliance

Pro

blem

Beh

avio

r

per

min

0.0

0.5

1.0

1.5

2.0

2.5

3.0

Sim

ple

FC

R

p

er m

in

0.0

0.5

1.0

1.5

2.0

Com

plex

FC

R

per

min

0.0

0.5

1.0

1.5

2.0

Tol

eran

ce R

espo

nse

pe

r m

in

0.0

0.5

1.0

1.5

2.0

100

BL FCT + EXT

Sim

ple

FCR

Com

plex

FC

R

Denial BL Denial and Delay Tolerance Training

Treatment Extension

Response Chaining

Meltdownsandaggression

“Playwithme”

“Excuseme,”waitsforacknowledgementfromparent,thensays,“Willyouplaywithme,please”withappropriatetoneandvolume

Saying,“okay”whileglancingatparentwhojustsaid“No,”Wait,”“Holdon,”or“inaminute”

5/23/2017

31

0.0T

oler

ance

Res

pons

e

per

min

0.0

0.5

1.0

1.5

2.0

Sessions5 10 15 20 25 30 35 40 45 50 55 60 65 70

R

espo

nse

to

Inst

ruct

ions

(%

)

0

25

50

75

100

Rei

nfor

cem

ent

(%)

0

25

50

75

100

Gail

1 2 3

Compliance

Noncomp.

Levels

Visits

2

Calendar Days (2012-2013)

3 6

12/1

312

/14

7

8

9 10

11

12

13

14

1/18

1/21

1/22

1/25

1/29

2/1

2/4

2/5

2/6

15

2/12

16 17 18 19

2/15

2/18

2/19

2/20

20

3/1

21

3/2

22

3/8

Reinforcement:TimewithMom’sundividedattentionandpreferredtoys

Compliance:DoingwhateverMomaskedhertodoquicklyandcompletely

Tol

eran

pe

0.0

0.5

Sessions10 20 30 40 50 60 70 80 90 100

R

espo

nse

to

Inst

ruct

ions

(%

)

0

25

50

75

100

Rei

nfor

cem

ent

(%)

0

25

50

75

100

Dale

Visits

1

Calendar Days (2013)

2 3

1/24

1/25

4

5

6 7

8

9

10

11

1/30

1/31

2/1

2/5

2/6

2/12

2/15

2/22

2/26

12

2/28

13 14 15 16

3/1

3/5

3/6

3/8

17

3/13

18

3/20

19

3/24

20

3/27

21

3/29

22

4/2

23

4/3

4/5

24

25

4/10

26

27

4/11

4/12

28

4/19

29

4/24

30

4/26

1 2 3

Compliance

Noncomp.

31

5/2

Levels

BL FCT + EXTDenial BL Denial and Delay Tolerance TrainingTreatment

Analysis

Dale

11‐yearoldboy

diagnosedwithAutism

PROGRESSIVE INCREASE IN COMPLEXITY OF INSTRUCTIONS

1 Simple motor movementsWalk over here, stand up, sit down,

clap your hands, touch your (shoulder, head, toes)2 Simple academics Draw a circle, write your name, copy what I write

Homework/Task preparationUnzip your backpack, take out the book, erase the board

come to the board, put these books on the book shelf

3 Complex academic: Reading skillsRead this paragraph, Answer this question….,

Sound out the wordsComplex academic: Math skills Solve this (addition, subtraction etc…)

Self-help skills Wash your hands, do this chore (e.g., organizing chairs)Play skills Throw or kick the ball

TreatmentAnalysis

Dale

11‐yearoldboy

diagnosedwithAutism

Pro

blem

Beh

avio

r

per

min

0

2

4

6

8

10

12

14

Sim

ple

FC

R

p

er m

in

0

1

2

3

4

Com

plex

FC

R

per

min

0.0

0.5

1.0

1.5

2.0

Tol

eran

ce R

espo

nse

pe

r m

in

0.0

0.5

1.0

1.5

2.0

Rei

nfor

cem

ent

(%)

0

25

50

75

100

Dale

BL FCT + EXT

Sim

ple

FCR

Com

plex

FC

R

Denial BL Denial and Delay Tolerance Training

Treatment Extension

*

Response Chaining

Sessions

Visits

1


2 3

1/24

1/25

4

5

6 7

8

9

10

11

1/30

1/31

2/1

2/5

2/6

2/12

2/15

2/22

2/26

12

2/28

13 14 15 16

3/1

3/5

3/6

3/8

17

3/13

18

3/20

19

3/24

20

3/27

21

3/29

22

4/2

23

4/3

4/5

24

25

4/10

26

27

4/11

4/12

28

4/19

29

4/24

30

4/26

31

5/2

5/23/2017

32

Tol

eran

pe

0.0

0.5

Sessions10 20 30 40 50 60 70 80 90 100

R

espo

nse

to

Inst

ruct

ions

(%

)

0

25

50

75

100

Rei

nfor

cem

ent

(%)

0

25

50

75

100

Dale

Visits

1


2 3

1/24

1/25

4

5

6 7

8

9

10

11

1/30

1/31

2/1

2/5

2/6

2/12

2/15

2/22

2/26

12

2/28

13 14 15 16

3/1

3/5

3/6

3/8

17

3/13

18

3/20

19

3/24

20

3/27

21

3/29

22

4/2

23

4/3

4/5

24

25

4/10

26

27

4/11

4/12

28

4/19

29

4/24

30

4/26

1 2 3

Compliance

Noncomp.

31

5/2

Levels

BL FCT + EXTDenial BL Denial and Delay Tolerance TrainingTreatment

Analysis

Dale

11‐yearoldboy

diagnosedwithAutism

MANNER IN WHICH TREATMENT WAS EXTENDED TO FAMILY AND HOME• Three analysts alternated while parents observed the sessions• Following training, the father was introduced after the analyst presented the evocative trial and

halfway through the session; the mother was present in the session room• The mother implemented treatment in the session room• Parents varied the type and amount of instructions during the delay period• Parents implemented treatment in the home while novel instructions were introduced

Treatment Extension

Takeamomenttoreflectonthisparticulartreatmentprocess.

Howisitsimilartoanddifferentthanthetreatmentyouimplement?

Discusswithyourneighbor.

TimeAssessment

Steps

# of Visits (1 hr each)

Cost (in US dollars)

Range Mean Range Mean

1* Interview -- 1 -- 200

2* Functional Analysis 1 - 4 2.3 166 - 800 467

3 Functional Communication Training

1 - 3 2 200 - 534 400

4 Complex FCT 1 - 4 2.4 200 - 860 487

5 Tolerance Response Training

2 - 7 4.6 300 - 1400 913

6 Easy Response Chaining 1 - 5 2.6 200 – 960 520

7* Difficult Response Chaining 2 - 11 5.1 400 - 2240 1,013

8* Treatment Extension 4 - 9 7.3 800 - 1800 1,467

Totals: 23 - 32 27 5,467

Supervision meetings: 16 - 28 20 1000 - 1750 1250

Report writing / planning: -- 4 -- 500

Grand Totals: 6225 - 8650 7,217

5/23/2017

33

CostAssessment

Steps

# of Visits (1 hr each)

Cost (in US dollars)

Range Mean Range Mean

1* Interview -- 1 -- 200

2* Functional Analysis 1 - 4 2.3 166 - 800 467

3 Functional Communication Training

1 - 3 2 200 - 534 400

4 Complex FCT 1 - 4 2.4 200 - 860 487

5 Tolerance Response Training

2 - 7 4.6 300 - 1400 913

6 Easy Response Chaining 1 - 5 2.6 200 – 960 520

7* Difficult Response Chaining 2 - 11 5.1 400 - 2240 1,013

8* Treatment Extension 4 - 9 7.3 800 - 1800 1,467

Totals: 23 - 32 27 5,467

Supervision meetings: 16 - 28 20 1000 - 1750 1250

Report writing / planning: -- 4 -- 500

Grand Totals: 6225 - 8650 7,217


Ratings







IISCAshaveledsocially‐validated outcomes

fromHanleyetal.,2014

PersonalizedSocialvalidityData

Parents' Comfort Level of Presenting the Evocative Situation

Comfort Levels

Questions Pre-treatment Post-treatment

Gail

1. Taking away toys 1 7

2. Telling child "no" when they ask for something 3 7

3. Giving instructions 5 7

Dale

1. Interrupting child's preferred activity and telling them to do homework or other non-preferred activities

4 6

Bob

1. Taking away DS or iPad at meal times 3 7

2. Taking away DS or iPad on a transition 3 7

3. Interrupting or correcting math work 3 7

Note. 7=very comfortable 1=not comfortable.

5/23/2017

34

Someopen‐endedresponsesfromtheSocialAcceptabilityQuestionnaire

SrComplexFCR

SrComplexFCR “No” Toleranceresponse

SrComplexFCR “No” Toleranceresponse Instruction C

SrComplexFCR “No” Toleranceresponse Instruction Compliance



SrComplexFCR

SrComplexFCR

SrComplexFCR “No” Toleranceresponse


Reinforcementis:Responserequirementis:Function‐based VariableDifferential UnpredictableIntermittentVariableinduration

5/23/2017

35

TreatmentImplementation

*Materialsnotneeded:LaminateLaminatingmachineGluegunsVisavismarkersVelcroTokensTokenboardsTimersStickersCandiesAnythingthatwasnotalreadyin

thechild’senvironment!

1. Puttheseinyourpocket2. Pulloneoutwhilechildis

experiencingtheirreinforcers

3. Keepittoyourself4. Requirethatbehaviornext

time

1. Spinit!2. Keepittoyourself3. Requirethatbehaviornext

time

Appcalled“NamesinaHat”

Appcalled“Roundom”

5/23/2017

36

TenUniqueAspectsofourApproach(continued)

7.Ourfunction‐basedtreatmentsarealwaysskill‐based

PublishedinBehaviorAnalysisinPracticein2008(availableforfreeatPubMedCentral)

TenUniqueAspectsofourApproach

Wealwaysincreasethecomplexity,flexibility,and/orinteractionalnatureoftheFCRbeforeteachingdelay/denialtolerance

SimpleFCR: (“Myway”or“Myway,please”)

ComplexFCR:“Excuseme”

Afterasecondortwo,“Yes,Billy”“MayIhavemyway,please?”“Willyouplaymyway,please?”

Afterasecondortwo,“Sure,Billy”

Sessions10 20 30 40 50 60

Tot

al R

espo

nses

per

Min

ute

0

5

10

15

20

25

30

PBInd. FCR

3-s + Immediate

Luke

3-s + Delayed

0- to 3-s + Immediate

5

10

BL FCT

Prompting:Immediatethenfaded.

5/23/2017

37

Sessions

5 10 15 20 25

Agg

ress

ion

&D

isru

ptio

ns(r

pm)

012345

"Exc

use

me?

"[p

ause

]"M

ay I

hav

em

y w

aypl

s?"

(rpm

)

012345

"My

way

pls"

(rp

m)

012345

BL FCT + EXT

"May

I h

ave

my

way

pls?

" (r

pm)

012345

"Exc

use

me

may

I h

ave

my

way

pls?

" (r

pm)

012345

Jeff

Step 1

Step 2

Step 3

Step 4Shapethecomplexresponse

Differentiatethecomplexresponse

ImplementationquestionsregardingFCT?

Tips:1. Teachasimpleomnibusmand ratherthantrytoteachspecificmands fordifferentreinforcers atfirst.• Specificmands canbetaughtonceproblembehavioriszeroandtheomnibus

mand isoccurringindependently.

2. Relyonanovelmand ratherthanapre‐existingmand.3. Doeverythingpossibletoavoidchainingproblembehaviorwiththetargetmand.• Forinstance,becarefulofpromptingthenovelmand afteremissionofpb

o Eitherletextinctionofpb occurviatimeoutoruseanerrorlesspromptingtacticsuchasmosttoleastprompting

4. Startoutfastandsweaty;endslowandcool.

5/23/2017

38

ComeupwithatleastonequestionrelevanttoimplementingFunctionalCommunicationTraining(FCT)

TenUniqueAspectsofourApproach

9.Wealwaysexplicitlyteachdelay/denialtolerance

Thistakesupmostofourtimewithchildrenandfamilies(notthefunctionalassessmentorteachingtheFCRs)

Firstteachanexplicitresponsetoavarietyofdisappointmentsignals,thentomaketreatmentpractical:

• Chainimportantbehaviortothetoleranceresponse(thereisalwaysaprogressive component—agradualincreaseintime,stakes,orboth)

Asdelayincreases,FCRweakens&probabilityofPBincreases

WithonlyProgressiveReinforcementDelay:

5/23/2017

39

Sessions10 20 30 40

0

2

4

6

8

10No

DelayTerminal

Delay(no EXT)

NoDelay

NoDelay

TBPD(with EXT)

CBPD(with EXT)

Alex

Prob

lem

Beh

avio

r pe

r m

in

Scheduled Delay

Mean Experienced Delay

10 20 30 40

Res

pons

es p

er m

in

0.0

0.6

1.2

1.8

Ind TR

Ind FCR

Sessions

Time‐basedvs.Contingency‐basedProgressiveDelay

(LeadAuthor:MahshidGhaemmaghami)

Time‐basedvs.Contingency‐basedProgressiveDelay(LeadAuthor:Mahshid

Ghaemmaghami)

0

20

40

60

80

100

0

1

2

3

0

20

40

60

80

100

0

1

2

3

4

5

0

20

40

60

80

100

Pro

blem

Beh

avio

rpe

r m

in

0

1

2

3

0

20

40

60

80

100

App

ropr

iate

Res

pons

espe

r m

in

0

1

2

3

4

FCRTolerance Response

NoDelay

Terminal DelayWithout Extinction

NoDelay

NoDelay

NoDelay

Time-BasedProgressive Delay

Contingency-BasedProgressive Delay (CBPD)

Context 1

CBPD

% of S

ession Engaged in

Em

otional Responding

Dur

atio

n of

Del

ay (

s)

0

100

200

300

400

ScheduledExperienced

Sessions5 10 15 20 25 30 35 40 45 50 55

0

100

200

300

400


% of D

elay Interval Engaged in

Alternative A

ctivity

Context 2

Context 1

Context 2

Context 1

Context 2

Jack

Time‐basedvs.Contingency‐basedProgressiveDelay(LeadAuthor:Mahshid

Ghaemmaghami)

0

20

40

60

80

100

0

1

2

3

0

20

40

60

80

100

0

1

2

3

4

5

0

20

40

60

80

100

Pro

blem

Beh

avio

rpe

r m

in

0

1

2

3

0

20

40

60

80

100

App

ropr

iate

Res

pons

espe

r m

in

0

1

2

3

4

FCRTolerance Response

NoDelay


NoDelay

NoDelay

NoDelay

Time-BasedProgressive Delay

Contingency-BasedProgressive Delay (CBPD)

Context 1

CBPD

% of S

ession Engaged in

Em

otional Responding

Dur

atio

n of

Del

ay (

s)

0

100

200

300

400

ScheduledExperienced

Sessions5 10 15 20 25 30 35 40 45 50 55

0

100

200

300

400


% of D

elay Interval Engaged in

Alternative A

ctivity

Context 2

Context 1

Context 2

Context 1

Context 2

Jack

5/23/2017

40

5CriticalAspectsofDelay/DenialToleranceTraining

1. Alwaysprovideimmediatesr forsomeFCRs

2. Teachanappropriateresponsetomultiplecuesofdelay,denial,ordisappointment

3. Progressivelyincreasetheaverageamountofbehavior (notjusttime)requiredtoterminatethedelay

4. Terminatethedelayforvarious amountsofbehavior(sometimesexpectverylittlebehaviorsometimesrequestlargerormorecomplextypesofbehaviorduringthedelay)

5. Probablybesttonotsignalhowmuchbehaviorisrequiredtoterminatethedelays

ComeupwithatleastonequestionrelevanttoimplementingDelay/DenialToleranceTraining

• Nominatethecriticalfeaturesofprogrammingtoteachchildrentotoleratedelaystothereinforcersmaintainingtheirproblembehavior.a. oncecompliancechainsareacquired,always

delaythereinforcerfollowingafunctionalcommunicationresponse

b. teachanappropriateresponsetodelayanddenialcuesbyprovidingpreferredcandywhenthechilddoesnotmeltdownfollowingadelayordenialcue

c. endthedelaywhentheamountoftimedeterminedpriortosessionshasexpired

d. reinforcethefunctionalcommunicationresponseimmediatelyatleastsomeofthetime

e. enddelayswhenthechildhasengagedinasufficientamountofanappropriateactivity

5/23/2017

41

• Inthisskill‐basedprogram,reinforcementis:a. function‐basedasopposedtoarbitraryb. differentiallydeliveredasopposedto

noncontingentc. continuousasopposedtointermittentd. consistentasopposedtovariablein

duratione. fairlyunpredictableasopposedtohighly

predictable

• Nominatethecriticalaspectsofdelayanddenialtolerancetraining.a. progressivelyincreasetheaverageamountofbehaviorrequiredtoterminatethedelay

b. teachanappropriateresponsetomultiplecuesofdelay,denial,ordisappointment

c. alwaysprovideimmediatereinforcementforsomefunctionalcommunicationresponses

d. donotsignalhowmuchbehaviorisrequiredtoterminatethedelays

e. terminatethedelayforvariousamountsofbehavior

• Fromthelistbelow,nominatetheitemsusuallynotnecessarywhenimplementingthetreatmentacrosstheday:a. Laminateandlaminatingmachineb. Gluegunsc. Visavis markersd. Velcroe. TokensandTokenboardsf. Timersg. Stickersh. Candies

5/23/2017

42

Comeupwithatleastonequestionrelevanttoimplementingthefunction‐basedtreatmentasdescribed.

Then,let’stalklogistics.

Afinalmessage

WithAutism,thereisahigherlikelihoodofproblembehavior

MeltdownsAggressionSelf‐injury

References:Baghdadli,Pascal,Grisi,&Aussilloux,2003;Horneretal.,2002;Kimetal.,2000;Murphy,Healy,&Leader,2009;Thompson,2009

freedom

fromthesebehaviorsforpersonswithAutismandtheircaregivers

isattainable

5/23/2017

43

Itisattainableformost

withoutdrugs

withouthospitalization

withoutharshpunishment

withoutcandies,stickers,andtokenboards

Itisattainable

byfirstunderstanding*whythechildisengagingintheproblembehavior

understandingcanberealizedquickly,safely,andanalytically

Itisattainable

whenchildrenaretaughtskills*tohelpthemnavigateourcomplexsocialworld

*Communicationandtoleration

5/23/2017

44

Itisattainable

whentheskillsaremaintainedviaunpredictableandintermittentreinforcement

whichisprobablythesamearrangementthatmaintainedthevariousformsofproblembehavior

GregoryP.Hanley.Ph.D.,BCBA‐D

AddressingStereotypyTheImportanceofaBalancedApproach

tothisCoreSymptomofAutism



PersonsdiagnosedwithAutism

oftenengageinrepetitiveacts

thatappeartoservenofunction

5/23/2017

45

Theseactsarecollectivelyreferredtoas

stereotypy

duetotheformalsimilarityoftheacts

andtheperiodicitywithwhichtheyareemitted

5/23/2017

46

HFA = High functioning autism

LFA =Low functioning autism

DLD = Developmental language disorder

NALIQ = Non‐autistic low IQ

Stereotypycanservedifferentfunctions

FromHanley,Iwata,andMcCord,JABA,2003,p.166

Stereotypyisusuallymaintainedby

sensory(automatic)reinforcement)

5/23/2017

47

WhenisStereotypyaProblem?

….whenitisexhibitedwithimpairing frequency



whenitinterfereswithattemptstoteachskillsorconcepts



whenitinterfereswithsocialinteractions

5/23/2017

48



whentheprohibitionofstereotypyresultsinmoreseriousproblembehavior

(DeLeon etal.,2011)

• Threeteenagers– Jon,Patrick,&Edward

• Stereotypy– Handflapping,fingertappingorflicking,bodyrocking,mouthing,eyepressing,earholding

Someapplicationsofthemodel

5/23/2017

49

Sessions

3 6 9 12 15

Res

pons

es p

er m

in(S

tere

otyp

y)

0

2

4

6

8

10

12

14Attention EscapeAlone Control

Jon

Sessions

2 4 6 8 10 12R

espo

nses

per

min

(Ste

reot

ypy)

0

2

4

6

8

10

AttentionEscapeAlone Control

Patrick

Step1:Functionalanalysis

Sessions

3 6 9 12

Res

pons

es p

er m

in(S

tere

otyp

y)

0

2

4

6

8

10

Attention EscapeAlone Control

Edward

ConclusionStereotypyisprobablymaintainedbyautomaticreinforcement

Step2:Conductapreferenceassessment

Seethesestudiesforthesuccessfultreatmentofstereotypybyprovidingfreeaccesstomaterialsidentifiedviapreferenceassessment

Favell,McGimsey,&Schell(1982)AIDD

Piazza,Adelinis,Hanley,Goh,&Delia(2000)JABA

Roscoe,Iwata,&Goh(1999)JABA

Step2:PreferenceAssessment

Du

rati

on (

in s

ec)

Sim

ple

En

gage

men

t

50

100

150

200

250

300

Items

BeadsLinks

StampsDinos

Intersta

rs

Play D

ohCups

Lite Brite

Res

pon

se p

er m

in(S

tere

otyp

y)

2

4

6

8

10

12

14

Jon

Items

Shape Sorte

r

Intersta

rsLegos

Lite Brite

Matching

StampsBead

s

Etch-a-

sketch

Stickers

Patrick

Items

ControlBead

s

Shape Sorte

rLaci

ng

Intersta

r

StampsLinks

Lite Brite

Legos

Edward

5/23/2017

50

Step2:PreferenceAssessment

Du

rati

on (

in s

ec)

Sim

ple

En

gage

men

t

50

100

150

200

250

300

Items

BeadsLinks

StampsDinos

Intersta

rs

Play D

ohCups

Lite Brite

Res

pon

se p

er m

in(S

tere

otyp

y)

2

4

6

8

10

12

14

Jon

Items

Shape Sorte

r

Intersta

rsLegos

Lite Brite

Matching

StampsBead

s

Etch-a-

sketch

Stickers

Patrick

Items

ControlBead

s

Shape Sorte

rLaci

ng

Intersta

r

StampsLinks

Lite Brite

Legos

Edward

ConclusionReinforcers earnedviaitemengagementwereneithersubstitutablefornordidtheyeffectivelycompetewithreinforcers earnedviastereotypy

Step3:AddPromptingofItemEngagement

Seethesestudiesforthesuccessfulapplicationofpromptingengagementwithfreelyavailabletoystoaddressstereotypy

Britton,Carr,,Landaburu,&Romick (2002)BI

Horner(1980)JABA

Lindberg,Iwata,&Kahng(1999)JABA

Jon

5/23/2017

51

Edward

Step3:AddPromptingofItemEngagement

Conclusion:Stereotypypersisted,so…..promptingapparentlydidnotresultinaccesstomoreorbetterreinforcers foritemengagement

Step4:Alterconsequenceofstereotypy‐‐addblocking

Seethesestudiesforthesuccessfultreatmentofstereotypybyblockingstereotypy

Lerman,&Iwata(1996)JABA

Reid,Parsons,Phillips,&Green(1993)JABA

Roscoe,Iwata,&Goh(1999)JABA

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Jon

Jon

Edward

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Step4:Alterconsequenceofstereotypy‐‐addblocking

Conclusion:Stereotypypersistedorworsened

Why?• Interpretationoffunctionalpropertiesofstereotypywasincorrect

• Onlysawearlystageofextinction• Arenotremovingallreinforcers (therewereintegritybreaches)

• Motivationtoproduceautomaticreinforcementwashighwithnootherwaytoproducesimilarreinforcers

Step5:AdddifferentialreinforcementtostrengthensomedesirablebehaviorSeethesestudiesforthesuccessfultreatmentofstereotypyviadifferentialreinforcement

Charlop,Kurtz,&Casey(1990)JABA

Hanley,Iwata,Thompson,&Lindberg(2000)JABA

Wolery,Kirk,&Gast (1985)JADD

Jon

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Edward

Patrick

Thetreatment–

activitiesprompting(teaching)

blockingwhile teachingearnedaccesstostereotypy

canthenbeusedtoteachmorecomplexplayskills

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Sessions

10 20 30 40 50 60 70 80 90 100 110 120

0

5

10

15

20

# of Rs / FormRequirements

12345678910

0

5

10

15

20

Jon

Baseline

Res

pon

ses

per

min

Treatment for Shaping Specific Forms of Functional Engagement

Stereotypy

Prompted SFE

Specific FunctionalEngagement

/ 1 post on I-bar/ 2 posts on I-bar/ 3 posts on I-bar/ 4 posts on I-bar/ I-bar on posts (1 cube)

/ 2 cubes

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Sessions

10 20 30 40 50 60 70 80 90

0

3

6

9

12

15

# of Rs / FormRequirements

123456789101112

0

3

6

9

12

15

StereotypySpecific Functional Engagement (SFE)Prompted SFE

EdwardBaseline

Res

pons

es p

er m

in

Treatment for Shaping Specific Forms of Functional Engagement

/ 1 Lego/ 2 Legos/ 3 Legos/ 4 Legos/ 5 Legos

/ 2nd House

/ 6 Legos / 1st House

Isthisahumanetreatment?

Arestaffwillingtoimplementthesetreatments?

Doesthepersonwithstereotypylikeorloathethistreatment?

Table 2

Questions and Results of the Social Validity Questionnaire Responses

Questions Mean (range)1. Do you think that the treatment that involved prompting engagement, blocking stereotypy, and differentially reinforcing engagement with 30 s access to the participant’s own stereotypy was acceptable?

7.0

2. Do you think that the amount of behavior change was acceptable and sufficient?

6.6 (6 - 7)

3. I feel that the overall goals of this treatment were acceptable, appropriate and important for the individual.

6.6 (5 - 7)

4. I would recommend this treatment package to other therapists/providers that are attempting to decrease motor stereotypy and increase age-appropriate play skills.

6.8 (6 - 7)

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Similarinquiry,differentrespondent:Whichtreatmentdideachteenagerprefer?

Orange

Purple

Light Blue

Hot Pink

Royal Blue

White Pink

Teal

% S

elec

ted

0

10

20

30

40

50

60

70

80

90

100

Colors

Jon

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Blocking OnlyPink Card

Light Blue Card

Royal Blue Card

FR-1

Activities Only

Activities, Blocking, andContingent Access to Stereotypy

Initial Links Terminal Links

Contingency:

Trials

12 24 36 48 60 72 84 96 108 120 132 144 156 168 180

Cu

mul

ativ

e #

of S

elec

tion

s

0

4

8

12

16

20

24

28

32

36

40

44

No Differential Consequences for Selections

Differential Consequences for Selections

Jon

Pink Blocking only Light Blue Activities only Royal Blue Tx Package

Link Colors Correlated Treatments

(1) (2) (5)(3) (4) (6) (7) (8) (9) (10)(11)(12)(13)

(Sessions)

(14)(15)(16)(17)(18)(19)(20)


(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)

Trials

6 12 18 24 30 36 42 48 54 60

Cu

mu

lati

ve #

of

Sele

ctio

ns

0

2

4

6

8

10

12

14

16



Patrick

(1) (2) (5)(3) (4) (6) (7) (8) (9) (10)

(Sessions)


Pink Blocking onlyYellow Activities only


Green Tx Package

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Trials

12 24 36 48 60 72 84 96 108 120 132 144 156 168

Cu

mu

lati

ve #

of

Sele

ctio

ns

0

4

8

12

16

20

24

28

32

36

40

44



Edward

Blue Tx Package

Green Blocking Only Orange Activities Only


(1) (2) (5)(3) (4) (6) (7) (8) (9)(10)

(Sessions)

(11)(12) (13)(14) (15)(16)


(17)(18) (19)(20) (21)(22) (23)(24) (25)(26) (27)(28)

ResultsSummary

Noonepreferredblockingonly

Nooneavoidedthetreatmentwithallthreecomponents

Twoofthreepreferredthetreatmentwithallthreecomponents

Whyapreferenceforthistreatment?

Preferenceforcontingencies?

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SomeTake‐HomePoints

Don’tassumefunction

Testforsensitivitytosocialreinforcers first;see:


Itisimportanttorecognizethenecessityandinsufficiencyofblockingasatreatmentforstereotypy


Immediatetreatmentgoalisnotelimination ofstereotypy

Moreappropriategoalishavingitoccurinacceptableplacesandatacceptabletimes

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Canwesimplyobtainstimuluscontroloverstereotypy?

Yes– butthenotionofacontingencyisimportantheretoo.

Multipleschedule

• S‐:stereotypyblocked• S+:stereotypyallowed

• ChangeoverbetweenS‐

andS+ componentsistime‐based

Chainedschedule

• S‐:stereotypyblocked• S+:stereotypyallowed

• ChangeoverbetweenS‐

andS+ componentsiscontingent

0

5

10

40MultipleChained

0

6

12 S-

0

20

40

0

15

30 S+

0

5

10

0

10

209 20 40

FR Schedule

30

0

5

10

0

10

20FR Schedule

123 5 7 10 20S- A

verage component

duration (minutes)

10 20 30 400

5

10

Max

10 20 30 40 500

5

10

Molly

S+

Ste

reot

ypy

per

min

Item

eng

agem

ent p

er m

in

Sessions

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0

5

10

40MultipleChained

0

6

12 S-

0

20

40

0

15

30 S+

0

5

10

0

10

209 20 40

FR Schedule

30

0

5

10

0

10

20FR Schedule

123 5 7 10 20S- A

verage component

duration (minutes)

10 20 30 400

5

10

Max

10 20 30 40 500

5

10

Molly

S+

Ste

reot

ypy

per

min

Item

eng

agem

ent p

er m

in

Sessions

0

5

10

40MultipleChained

0

6

12 S-

0

20

40

0

15

30 S+

0

5

10

0

10

209 20 40

FR Schedule

30

0

5

10

0

10

20FR Schedule

123 5 7 10 20S- A

verage component

duration (minutes)

10 20 30 400

5

10

Max

10 20 30 40 500

5

10

Molly

S+

Ste

reot

ypy

per

min

Item

eng

agem

ent p

er m

in

Sessions

0

5

10

40MultipleChained

0

6

12 S-

0

20

40

0

15

30 S+

0

5

10

0

10

209 20 40

FR Schedule

30

0

5

10

0

10

20FR Schedule

123 5 7 10 20S- A

verage component

duration (minutes)

10 20 30 400

5

10

Max

10 20 30 40 500

5

10

Molly

S+

Ste

reot

ypy

per

min

Item

eng

agem

ent p

er m

in

Sessions

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Okay,butdideitheryieldstimuluscontroloverstereotypy?

0

50

100

S-S+

0

50

100

Chained

0

50

100

0

50

100

Multiple

0

50

100

0

50

100

Chained

10 20 30 400

50

100

Max

10 20 30 40 500

50

100

Multiple

Molly

Sessions

Lat

ency

to

ster

eoty

py(%

tim

e el

apse

d)L

aten

cy t

o en

gage

men

t(%

tim

e el

apse

d)

0

50

100

S-S+

0

50

100

Chained

0

50

100

0

50

100

Multiple

0

50

100

0

50

100

Chained

10 20 30 400

50

100

Max

10 20 30 40 500

50

100

Multiple

Molly

Sessions

Lat

ency

to

ster

eoty

py(%

tim

e el

apse

d)L

aten

cy t

o en

gage

men

t(%

tim

e el

apse

d)

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0

50

100

S-S+

0

50

100

Chained

0

50

100

0

50

100

Multiple

0

50

100

0

50

100

Chained

10 20 30 400

50

100

Max

10 20 30 40 500

50

100

Multiple

Molly

Sessions

Lat

ency

to

ster

eoty

py(%

tim

e el

apse

d)L

aten

cy t

o en

gage

men

t(%

tim

e el

apse

d)

Okay,butdideitheryieldstimuluscontroloverstereotypy?

Yes– Thechainedschedule.

Thenotionofacontingencyisimportantheretoo.

Dochildrenprefer

time‐basedalternation(multipleschedules)

or

behavior‐basedalternation(chainedschedules)?

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3 6 9 12

0

2

4

6

8

10

MultipleChainedExtinction

Max

Free choice

Cum

ulat

ive

sele

ctio

ns

3 6 9 12 15

0

2

4

6

Molly

Free choice Forced choice Free choice

Trials

Thesechildrenpreferredbehavior‐basedalternation(chainedschedules)

Whentreatingstereotypyarewemissingsomeimportantopportunities?

Canweaddresstheothercoredeficitsofautism(languageandsocial)whileaddressingstereotypy?

Canweallowthechildmorecontroloverwhereandwhentoengageinstereotypy?

Canwemakethetreatmentmoreflexiblesoitfitsintoeverydaylifealittlebetter?

Ithinkwecan.

NewAlternative:Skill‐BasedTreatmentPermission/Check‐inbasedmodelinwhichcommunication,toleration,andcontextuallyappropriatebehaviorsarestrengthened(Hanley,Jin,Vanselow,&Hanratty,JABA,2014)

1. Teachchildtorequestaccesstostereotypy(viablockingandcontingentaccesstostereotypy)

2.Teachchildtotoleratedenialsofmands forstereotypy(viablockingandcontingent,intermittent,andunpredictableaccesstostereotypy)

3.Teachchildtoengageincontextuallyrelevantbehavior(viaprompting,blockingandcontingent,intermittent,andunpredictableaccesstostereotypy)

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Level Task Longest chain of demands

Total demands Field size

1 Matching pictures 3 12 3

2 + Matching numbers, letters 3 12 3

3 (Same as above) 6 18 3





8 + Matching objects 10 27 6

9 + ADLs 10 27 6

10 + Receptive ID of pictures 10 27 6

ResponseChainingSequence

0

25

50

75

100

0

5

10

15

20

BL

S-S+

FCT TRT Response Chaining

Mot

orst

ereo

typy

% o

f co

mpo

nent

S- duration (min)

0

5

10

15

20

Sim

ple

FC

Rpe

r m

in

0

2

4

6

15

Com

plex

FC

Rpe

r m

in

0

2

4

6

TR

per

min

20 40 60 80 1000

25

50

75

100

0

20

40

60

801 2 3 4 7 5 6 7 8 94 10

Milo

Sessions

Acc

urac

y (%

) # demands

Question Rater 1 Rater 2

The treatment that involved teaching a request for stereotypy, teaching an appropriate response to the denial of that request, and teaching the individual to complete an increasing number of demands before earning access to stereotypy was acceptable.

7 7

The amount of behavior change (i.e., the effects of treatment) was acceptable or sufficient.

7 7

The overall goals of this treatment were acceptable, appropriate, and important for the individual.

7 7

I would recommend this treatment package to other therapists or providers who are attempting to decrease stereotypy and increase appropriate engagement.

7 7

SocialValidityResults

5/23/2017

67

FC

R p

er m

in

0

10

20

30

40

Grant

*

TR

per

min

0

5

10

15

20

Sessions

20 40 60

Com

pli

ance

(%

)

0

20

40

60

80

100#

dem

ands

co

mp

lete

d

0

20

40

60

80

100S-

dur

atio

n (

min

)

0

2

4

6

8

10

Mot

or

ster

eoty

py

% o

f co

mp

one

nt

0

20

40

60

80

100

S-S+

Al. BL FCT TR RC Exten .[1] [2] [3] [4] [5] [1] [2]

l ses

sion

s {

1 = Strongly disagree 7 = Strongly agree

1. The treatment that involved teaching a request for stereotypy, teaching an appropriate response to the denial of that request, and teaching the individual to complete an increasing number of demands before earning access to stereotypy was acceptable.

7

2. The amount of behavior change (i.e., the effects of treatment) was acceptable or sufficient.

6

3. The overall goals of this treatment were acceptable, appropriate, and important for the individual.

7

4. I would recommend this treatment package to other therapists or providers who are attempting to decrease stereotypy and increase appropriate engagement.

7

NextStep

Evaluategenerality oftheskill‐basedtreatmentindifferentcontextsandwhenappliedunderlongerperiodsbyrelevantteachersandcaregivers

Evaluatetreatmentwhenappliedto:HandmouthingScriptingInteractive,imaginativeplay

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68

FinalTake‐HomePoints

Treatmentforstereotypy….

canbefunction‐based

shouldbecomprehensive

shouldinvolveastrong,intermittent,andunsignaled contingencytoinhibitstereotypyanddosomethingelsecontextuallyappropriateinordertoengageinstereotypy

Forautomaticallyreinforcedstereotypy:Permissionbasedmodelinwhichcommunication,toleration,andcontextuallyappropriatebehaviorsarestrengthenedviaintermittentandunpredictableaccesstostereotypy

1. Teachchildtorequestaccesstostereotypy(viablockingandDR)

2.Teachchildtotoleratedenialsofmands forstereotypy(viablockingandcontingent,intermittent,andunpredictableaccesstostereotypy)

3.Teachchildtoengageincontextuallyrelevantbehavior(viablockingandcontingent,intermittent,andunpredictableaccesstostereotypyandprompting)

Goodluckwithallthatyoudoforallwhoyouteachandprovidecare


Contactinfo.:GregoryP.Hanley,Ph.D.,BCBA‐D

PsychologyDepartmentWesternNewEnglandUniversity

1215WilbrahamRoadSpringfield,Massachusetts01119

[email protected]

3 part pres (ho) 5 23 17 - · pdf file03.05.2016 · 5/23/2017 1 gregory p. hanley...

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