Assessment and treatment of severe problem behavior: A clinical application of a single-test IISCA followed by FCT

We examined the effectiveness of functional communication training (FCT) with an 8-year old boy with autism who engaged in problem behavior (e.g. aggression, self-injurious behavior, physical disruption). FCT is a form of differential reinforcement of alternative behavior that teaches a socially acceptable response to replace problem behavior (Carr & Durand 1985; Tiger, Hanley, & Bruzek 2008). FCT with extinction has been shown to be an efficacious treatment for decreasing a diverse range of problem behavior in both children and adults with and without developmental disabilities (Tiger et al. 2008). FCT requires the reinforcers maintaining problem behavior be identified through a functional assessment in order to then teach a communication response to obtain the same reinforcers. A functional analysis is an experimental procedure for identifying the reinforcers of problem behavior. The first purpose was to evaluate the efficacy of a more efficient and practical functional analysis, a single-test interview-informed synthesized contingency analysis (Hanley, Jin, Vanselow, & Hanratty, 2014), in identifying the maintaining variables of problem behavior. The second purpose was to demonstrate the efficacy of a gradual shaping procedure for increasing the complexity of an independent communication response without a resurgence of problem behavior. A single-test IISCA was conducted to identify the variables maintaining the problem behavior (Hanley et al. 2014). A reversal design was used to evaluate the effects of FCT with extinction for teaching a more socially appropriate communication response to replace problem behavior. This involved teaching a functional communication response (FCR) through a card exchange. The single-test IISCA was an effective and an efficient procedure for identifying the variables maintaining problem behavior. The results of the single-test IISCA were confirmed through treatment analysis, in which following the introduction of FCT problem behavior decreased to zero while independent FCRs increased to optimal levels to access the functional reinforcers