Newsletter
Volume 30 | 2007 | Number 3
Preventing and Reducing Challenging Behavior in Home Settings
By Dr. David P. Wacker & Dr. Jay W. Harding, The University of Iowa
In 1992, our research team at The University of Iowa Center for Disabilities and Development began conducting a series of research projects that were funded by the National Institute of Child Health and Human Development of the National Institutes of Health. Each project focused on the in-home assessment and treatment of young children (aged 6 years or younger) with developmental disabilities who displayed severe problem behavior such as aggression, self-injury, and property destruction. Referrals to these projects came from outpatient clinics at the University of Iowa and local school early childhood intervention teams within a 120-mile radius of Iowa City.
During the course of these projects, research team members scheduled weekly to monthly visits to participants’ homes. The parents in these projects served as therapists during in-home assessment and treatment procedures and received on-site consultation from the research team. All procedures were recorded on videotape for subsequent data collection and analysis.
Participants
To date, 86 children have enrolled in these projects (boys = 66, girls = 20). The average age was 3 years 9 months (range = 1 year 4 months to 6 years 11 months).
Estimated intellectual functioning for the children ranged from borderline to mild mental retardation (n = 57) and from moderate to profound mental retardation (n = 29). Many of the children in the project had additional diagnoses, including seizure disorder/cerebral palsy (n = 18), sensory disabilities (n = 22), autism spectrum disorders (n = 17), and genetic syndromes (n = 17), such as Down syndrome and fragile X syndrome.
Data Collection
We used a 6-s partial-interval recording system to collect data on multiple categories of child behavior. These categories included destructive behaviors (e.g., aggression, self-injury), other problem behaviors (e.g., screaming, elopement), targeted communication (manding), and social interactions such as toy play with parents. We also asked parents to complete a treatment acceptability survey, the Treatment Acceptability Rating Form-Revised (Reimers & Wacker, 1988 [TARF-R]), at the beginning and end of our
treatment procedures.
Procedures
Functional analysis. Parents conducted a functional analysis (Iwata, et al., 1982/1994) to test hypotheses regarding variables that maintained (reinforced) their child’s problem behavior. The functional analysis was conducted to identify appropriate treatment. When the function of problem behavior is known, treatment involves disrupting the response-reinforcer relation (e.g., extinction) and providing the known reinforcer contingent on a desired behavior (e.g., differential reinforcement of alternative behavior). Thus, a competition is created between problem behavior, which no longer receives reinforcement, and an alternative behavior, which is provided with a known reinforcer. In the absence of an identified response-reinforcer relation, treatment must be based on arbitrary reinforcers competing against unknown reinforcers.
We typically alternated assessment conditions within a multi-element design over several days. Table 1 shows the antecedent and consequence phases of the three test conditions (attention, tangible, and demand) evaluated within the functional analyses. We compared the three test conditions with a free play (control) condition. During the free play condition, the child had access to preferred toys, the parent provided non-contingent attention, and no demands were presented. These conditions were repeated until a consistent pattern of behavior was observed (e.g., a consistent elevation in problem behavior across one or more test conditions).
Table 1. Functional Analysis Test Conditions
Test Condition |
Antecedent |
Behavior |
Consequence |
Attention |
Attention diverted |
Problem behavior |
Attention provided |
Tangible |
Tangible removed |
Problem behavior |
Tangible returned |
Demand |
Demand presented |
Problem behavior |
Demand removed |
Functional communication training. Throughout our projects, we have used functional communication training (FCT; Carr & Durand, 1985) as a treatment program for most of the children. We trained the parents to teach their children an appropriate form of communication to produce a specific outcome: obtaining a reinforcer that was identified during the functional analysis. For example, children who engaged in problem behavior to gain parent attention during the functional analysis were taught an appropriate way to request parental attention. For children who displayed problem behavior to escape demands during the functional analysis, training focused on teaching the children to request assistance or a break from the demand.
We considered a number of variables in developing an effective FCT program for each child. First, the communicative response resulted in reinforcers that matched the identified function for problem behavior. Second, the response was efficient (i.e., easy for the child to perform). Third, the communicative response was based on the child’s speech and language abilities. Some children have difficulty producing vocal responses but are very capable of using a manual sign, word/picture card, or electronic device to communicate. In our projects, we typically provided the child with a multi-modal approach to communication. For example, a child who was being trained to ask for attention appropriately would be reinforced for saying or signing “Mom.” However, we also attached a photograph of the parent and the word “Mom” to a microswitch recording device that played, “Mom, play please” when activated. Thus, the child had multiple cues as to “what” to say and, if vocalizing was difficult, the child could sign or touch the photograph on the microswitch. Furthermore, the presence of the picture/word card and the microswitch served as a discriminative stimulus that manding would be reinforced.
We typically evaluated treatment within a reversal design. Baseline was an extinction condition that usually involved the absence of consequences for either appropriate or destructive behavior. Thus, for a demand condition, the demand continued regardless of the child’s behavior. FCT treatment involved a two-step chain: The child was first required to engage in a desired response (e.g., complete one step of a demand) and then to mand for the functional reinforcer. All problem behavior resulted in extinction. If the child engaged in destructive behavior during reinforcement (e.g., while on break), the reinforcement phase was terminated and the two-step chain was repeated.
Assessment and Treatment Results for Children Diagnosed With ASD
To date, we have enrolled 86 children in our research projects. Of these 86 children, 17 children (13 boys, 4 girls) were diagnosed with autism (9) or pervasive developmental disorder (8). The average age of this subgroup was 4 years 6 months (range = 2 years 8 months to 6 years 6 months), and estimated intellectual functioning ranged from mild delays to moderate mental retardation. All 17 children displayed destructive behavior, such as self-injury, aggression, and property destruction, as well as other forms of problem behavior, such as screaming, elopement, and noncompliance.
A functional analysis was conducted with all 17 children. Thirteen children displayed problem behavior that was maintained by both positive and negative reinforcement, 2 children showed behavior that was maintained by positive reinforcement, 1 child showed problem behavior maintained by negative reinforcement, and 1 child displayed an undifferentiated pattern of responding. Thus, 16 of the 17 children displayed problem behavior that was maintained by social contingencies.
Final treatment outcomes were available for 14 of the 17 children diagnosed with ASD. Twelve of these children showed a 90% to 100% decrease in destructive behavior compared to original baseline levels, 1 child showed an 87% decrease, and 1 child did not show improvement during treatment probes. The mean reduction in destructive behavior across all 14 children was 90%. Thus, the overall effects of the function-based treatment programs were encouraging.
Parent satisfaction with the program was evaluated by having parents complete the Treatment Acceptability Rating Form-Revised (Reimers & Wacker, 1988 [TARF-R]) at the end of their participation in the project. With regard to the question, “How acceptable do you find the treatment to be regarding your concerns about your child?” parents responded by indicating a number on a Likert-type scale that ranged from (1) Not at all acceptable to (7) Very acceptable. For parents who had children with ASD, the average rating on this question was 6.7 (range = 6 to 7).
References
Carr, E. G., & Durand, V. M. (1985). Reducing behavior problems through functional communication training. Journal of Applied Behavior Analysis, 18, 111-126.
Iwata, B. A., Dorsey, M. F., Slifer, K. J., Bauman, K. E., & Richman, G. S. (1982/1994). Toward a functional analysis of self-injury. Journal of Applied Behavior Analysis, 27, 197-209. (Reprinted from Analysis and Intervention in Developmental Disabilities, 2, 3-20, 1982)
Reimers, T., & Wacker, D. (1988). Parents’ ratings of the acceptability of behavioral treatment recommendations made in an outpatient clinic: A preliminary analysis of the influence of treatment effectiveness. Behavioral Disorders, 14, 7-15.
Author Note
These projects were supported by Grant #R01 HD029402 from the National Institute of Child Health and Human Development of the National Institutes of Health. The opinions expressed do not necessarily reflect the position or policy of that agency. We express our appreciation to the families who participated in these projects.
Address correspondence and requests for reprints to David P. Wacker, Center for Disabilities and Development, 100 Hawkins Drive, Room 251, Iowa City, Iowa, 52242-1011.