Association for Behavior Analysis International

Research has demonstrated the effectiveness of behavioral treatments, such as Functional Communication Training (FCT) and FCT with delay-and-denial tolerance training, for reducing challenging behavior. Relapse refers to the recurrence of a previously decreased response when a treatment is challenged, such as treatment integrity omission errors (i.e., resurgence) or when treatment is transferred from clinics to community settings, such as the home or school (i.e., renewal). Although effective, relapse following FCT is highly prevalent, and there is relatively little research evaluating relapse following FCT with delay-and-denial tolerance training. Additionally, there have been mixed findings across basic and applied studies, and guidance for practice is limited. In this symposium, one presentation investigates renewal following differential reinforcement of alternative behavior in single- and multiple-context training across basic and applied arrangements. Two presentations will highlight investigations of relapse during delay-and-denial tolerance training—one empirical demonstration of relapse following programmed treatment integrity errors and context changes during FCT with delay-and-denial tolerance training, and one systematic review of the magnitude and prevalence of resurgence during distinct components of delay-and-denial tolerance training. The final presentation will identify everyday examples of relapse and provide strategies and tools to assist practitioners in preparing for relapse in applied settings.

The intended audience is behavior analysts who have or currently work with individuals that engage in challenging behavior, as well as researchers who specialize in relapse. The audience should have some knowledge on treatment relapse and its clinical implications. Additionally, familiarity with experimental models of different forms of relapse will be useful, but a general overview will be provided for pertinent presentations.

Individuals with autism spectrum disorder (ASD) often receive behavioral treatment for severe problem behavior. Although treatment may be effective in reducing problem behavior, the possibility of renewal of problem behavior may be of a concern to clinicians and caregivers. Renewal is the reemergence of a previously reduced response following a change in treatment conditions (Pritchard et al., 2014). One potential solution to mitigate renewal may incorporate multiple implementers across different settings before implementing treatment in contexts in which the target behavior was initially reinforced (Kimball et al., 2023). Additionally, translational human laboratory studies are conducted under the assumption that outcomes will be relevant to clinical conditions. However, few studies have examined the extent to which laboratory preparations predict whether similar findings will be obtained with clinically relevant behaviors. During the present study, single- and multiple- context training was evaluated with human participants recruited via Amazon Mechanical Turk (MTurk) and individuals with ASD, who engaged in problem behavior. Across both studies, minimal renewal effects were observed following the implementation of DRA plus extinction for both single- and multiple-context participants.

Resurgence is the recurrence of target behavior (e.g., severe destructive behavior) during a worsening of reinforcement conditions (e.g., increases in response effort or decreases in reinforcement rate for appropriate behavior). Previous studies have examined the prevalence and magnitude of resurgence of severe destructive behavior during functional communication training with discriminative stimuli (i.e., multiple schedules). We conducted a systematic review of the literature to analyze the magnitude and prevalence of treatment relapse during functional communication training with delay-and-denial tolerance training, including during shaping of the complex communication response, introduction of tolerance responses, and increases in delays. Similar to previous studies with discriminative stimuli, resurgence occurred in nearly all participants (87%) and in about one-third of transitions. Resurgence was less likely to occur during response-effort manipulations (i.e., complexity training, tolerance-response training) and was most likely to occur during increases in delays that ended following the passage of time rather than a response criterion. These results highlight the importance of further evaluation of resurgence across different applications of functional communication training.