communication assessment for people who engage in behaviours of concern (boc) module 5 : functional...

Communication Assessment for People who engage in

Behaviours Of Concern (BOC)

Module 5 : Functional Communication Training

Hilary Johnson, Nick Hagiliassis, Barbara Solarsh,

Teresa Iacono, Jo Watson, Teena Caithness

Office of the Senior Practitioner, Disability Services, VictoriaOffice of the Senior Practitioner, Disability Services, Victoria

Functional Communication Training (FCT)CRITICAL QUESTION

• What are the differences between functional communication training (FCT)and teaching an individual to communicate in everyday situations (with a variety of partners, in a variety of settings)?

• What are the similarities?

Functional Communication Training (FCT)

FCT defined as a systematic intervention in which the behavior of concern is replaced by more socially appropriate behavior. (Sigafoos & Meikle, 1996)

– Replacement behavior is intended to serve the same purpose as the challenging behavior (Carr, 1988)

– Underlying notion that challenging behaviors are communicative intents (Durand, 1993; Skinner, 1957)

MAND

Functional Equivalence

• Myth #1

If I teach the person to communicate, unacceptable behaviour will no longer occur.

• Fact #1

Teach a mand that serves the same function as the unacceptable behaviour. The relationship between the mand and unacceptable behaviour is the key variable.

Step Description Rationale

1. Identify the functions of the unacceptable behaviour

Conduct a functional analysis of the unacceptable behaviour

If function is known, then use a response that is functionally equivalent.

2. Ensure the efficiency of the communicative responses that compete with unacceptable behaviour

Select a efficientcommunication response 1) physical effort2) amount of reinforcement and 3) delay to reinforcement

↑ effort &/or ↓ response &/or greater delay to reinforcement for communicative response, then no change to behaviour

3. Evaluate the reinforcers provided for unacceptable behaviour and communicative responses

Eliminate or ↓reinforcement for the unacceptable behaviour and ↑ reinforcement for the communicative response

= effort= response= reinforcementBoth will occur

Functional Communication Training

Kennethhits hisMum with a closed

fist

Request for

“Take me for a drive in the car”

Teach Kenneth to sign “car” as a

request

BOC Function FCT

Select KWS as a mand

Revie

w

BehaviourEffort of

ResponseDelay to

ReinforcementAggression (hitting his mother)

Kenneth must approach his mother and move his hand to his mother’s face or body

Minimal

Signing “car” Less than aggressionhowever he is already fisting his hands *

Longer than aggression (must be observed)

Touching a word card Less than aggression Longer than aggression (must be observed)

Using a voice output communication aid

Less than aggression Same as aggression (gives an auditory cue to his mother if message matches intent)

Procedure Functional description

Functional effect

Reprimand, redirect, or discuss

Kenneth is given attention by his mother, although he does not go in the car

Hitting is reinforced

Reduce amount / quality of attention

Brief neutral attention provided for hitting. More attention given for use of KWS

Reinforcement occurs, but the relative value & amount of reinforcement weakens the behaviour

Planned ignoring (extinction)

Hitting is ignored Reinforcement of hitting is eliminated

Time-out (nonexclusionary)

Mother looks away for a brief period for time (eg: 30 seconds) whenever hitting occurs

Reinforcement of hitting is eliminated, and Kenneth receives no attention for a brief period

Functional Communication Training

FCT involves assessment to determine the functions of behaviour and teaching the use of a more appropriate form of behaviour that serves the same function.

There are 3 stages:

1. Identify the Communicative Function of the BOC

2. Select an appropriate communicative alternative

3. Implement systematic instruction to teach the communicative alternative

FCT Systematic Review of Literature Miriam Chacon & Oliver Wendt (2006)

Evidence Based Practice (EBP)– Provide evidence about the effectiveness of FCT for

practitioners– Provide a systematic review which uses quantitative

measures to determine treatment effectiveness

Last review published in 1997 (Mirenda)

Research Question– Is FCT an effective treatment in decreasing aggressive

behaviors in individuals with autism?

FCT Systematic Review of Literature Miriam Chacon & Oliver Wendt (2006)

Speech (n=3) Vocalizations – replacement behaviour*• Braithwaite & Richdale (2000)• Day, Horner, & O’Neill (1994)• Sigafoos & Meikle (1996)

Manual Signs & Gestures (n=3) A combination of ASL manual signs and gestures*

• Day, Horner, & O’Neill (1994)• Sigafoos & Meikle (1996)• Wacker, et al. (1990)

Graphic Symbols (n=3) Line drawings and word cards*• Horner & Day (1991)• Schindler & Horner (2005)• Sigafoos & Meikle (1996)

FCT Systematic Review Results Miriam Chacon & Oliver Wendt (2006)

• FCT ranged from fairly effective to highly effective in the studies reviewed

• FCT yielded greater reduction of challenging behaviors when speech & manual signs/gestures were used as the replacement behaviors

– graphic symbols yielded the least amount of reduction of challenging behaviours

TABLE

Median

PND PRD

speech 97% 98%

manual signs & gestures 100% 100%

graphic symbols 65% 88%

Functional Communication Training

• FCT is successful although alone, it does not produce changes in the long run if other measures are not also addressed.

• Fading, extinction and other measures should be combined to ensure that the individuals continue to gain other skills while decreasing the use of challenging behaviours (Carr & Durand, 1985; Wacker et al, 1990)

• Continues research on FCT is needed

Boesch, M. C. & Wendt, O. (2009)Reducing self-injurious behaviors in individuals with autism: Benefits of functional communication training EBP Briefs 4(2), 1-11.

Where does FCT fit into a BSP?

Under the section Proactive Strategies “Teaching Skills”

• Communication Skills

• Independence *

• Coping skills *

However, you may also be working on receptiveand expressive communication supports for independence and coping skills in the three proactive strategy areas Change the Environment, Teaching Skills and Short-term Change Strategies

Functional Communication Training

Proactive strategies

What to do to prevent the behaviour

Immediate response strategies

What might help when the behaviours occur; beginning with least restrictive strategies?

Change the environment

Train communication partners to look for new skill

Add resources to support FCT

Teaching skills

Teach new skill to replace BOC

(long term)

Short-term change strategies for rapid change to behaviour

Teach new skill to replace BOC

(immediate)

Do not expect the individual to use FCT

Follow BSP

SUMMARY Pat Howlin (2006) pages 90-97• Developing communication in less able individuals

• Examining communicative functions important in BoC

• Analysis of “maladaptive” behaviours finds they are often most effective

• BoC lead to rapid and usually predictable responses from others

• Highly intensive experimental settings → lead to teach alternative ways (FCT)

• Detailed analysis of possible functions of undesirable behaviours required

• Quick fix 4 functions: Durand & Crimmins (1988) Motivational Assessment Scale

• Identify primary function of behaviour → alternate forms taught (FCT)

• Increasing general communicative ability– Transition from school to adulthood– Need to recognise an individual’s potential ability

• Possible to teach emotions – better if you start young

TransportersProf Simon Baron-Cohenhttp://www.thetransporters.com/index.html

The CAT Kit Dr Tony Attwood http://catkit-us.com/

• Developed by Dr. Tony Attwood, Dr. Kirsten Callesen and Dr. Annette Moller Nielsen

• Cognitive Affective Training (CAT) visual representation of feelings and emotions

• Includes a Manual, CAT-organizer, 9 Basic Feelings, The Measure, the Body, My circles, Timetables, Behaviour Palettes, the Wheel, CAT-book labels

Emotion Based Social Skills Training EBSSThttp://sigmaweb.com.au/westmead/

2004 HFASD + AS children 8-14 years + parents Pilot Study

2006 HFASD + AS children 8-14 years + parents RCT

2008 ASD + ID children 8-12 years + parents Pilot Study

2010 EBSST in Schools 7-12 years + parents Pilot Study

To Contact EBSST -Email us at: ebsst@chw.edu.auFax us at : 02 9845 2009Call us at : 02 9845 2005

Dr Karen JamesUniversity of Sydney

karen.james@sydney.edu.au

http://www.abc.net.au/rn/edpod/stories/2010/2938834.htm

22 July 2010 Learning to communicate at school

http://www.abc.net.au/rn/lifematters/stories/2010/2959173.htm

21 July 2010

Adolescents 12-16 years – Western Sydney

The Good Way Model Lesley Ayland and Bill West, NZ http://www.nzfvc.org.nz/accan/papers-presentations/abstract261v.shtml• Strengths-based model

• Uses Narrative therapy

• Originally developed for young people with DD

• Good Way

• Good House / Bad House

• Good Life

• Gang of 3 for abusive behaviourMr Sneaky, Mr Bully, Mr Just DoThe 3 Wise Men and their Box of Tools http://wellstop.org.nz/

Dr Pat MirendaUniversity of British Columbia

pat.mirenda@ubc.ca

• Worth seeing if you ever get a chance

• Possible visit to Australia in 2011

Planting Two Trees with One Seed: Communication supports for Problem Behaviour (2008)

http://www.ussaac.org/allthatjazzdocs/AACATJ.08.HO1.pdf

http://www.ussaac.org/allthatjazzdocs/AACATJ.08.HO2.pdf

References

Sigafoos, J., Arthur-Kelly, M. & Butterfield, N (2006) Enhancing Everyday Communication for Children with Disabilities (2006)Paul H. Brookes Publishing Co: Maryland USA

ISBN 1-55766-716-0

Koegel, L.K., Koegel, R.L & Dunlap, G. (1996) Positive Behavioral Support: Including People with Difficult Behavior in the Community

Paul H. Brookes Publishing Co: Maryland USA

ISBN 1-55766-228-2

ReferencesHowlin, P. (2004) Autism and Asperger Syndrome: Preparing for Adulthood (2nd edn) London: Routledge.

ISBN 0041530968 9

Reichle, J., Beukelman, D.R., & Light, J.C. (2002) Exemplary Practices for Beginning Communicators: Implications for AACPaul H. Brookes Publishing Co: Maryland USA

ISBN 1-55766-529-X

Focus Questions

Functional Communication Training (FCT)

Who assesses the behaviour?

Who provides a hypothesis for the function of the behaviour?

Who decides on the replacement behaviour?

Who creates the communication supports or strategies?

Who trains the replacement behaviour?

Who collects data to support the effectiveness or not of the replacement behaviour?

Who reviews the success or not of FCT?