A clinical application of functional communication training plus extinction and contingency-based delay under typical and socially-relevant contexts.

Functional communication training (FCT) plus extinction is an efficacious treatment of problem behavior that results in immediate and substantial reductions of problem behavior (Carr and Durand, 1985; Tiger, Hanley, & Bruzek, 2008). FCT plus extinction and reinforcement thinning (e.g., contingency-based delay (CBD), Ghaemmaghami, Hanley, & Jessel, 2016; Hanley, Jin, Vansleow, & Hanratty, 2014) has been shown to be an effective treatment for maintaining these treatment effects under more variable and practical reinforcement schedules. We examined a clinical application of FCT plus extinction and CBD with a 9-year-old boy with autism who engaged in severe problem behavior (e.g. aggression, self-injurious behavior, and physical disruption). An interview informed synthesized contingency analysis was used to identify the contextual environmental variables that maintain problem behavior. These variables were then used in FCT to teach a socially acceptable replacement communication response. CBD training was then used to teach the client appropriate waiting behaviors for when his requests could not be immediately granted in order to increase the practicality of treatment. Our goal was to extend the treatment to more natural and typical contexts that included extensive delays of 30 min or more as well as denials of requests. FCT combined with extinction was an efficacious procedure that resulted in an immediate elimination of problem behavior. The addition of CBD training resulted in an effective treatment that further maintained problem behavior at near zero levels while communication, tolerance, and compliance responses were increased and maintained at optimal levels. FCT plus extinction and CBD remained effective at practical and socially-relevant delay levels that included variable delays ranging from zero to 45 min as well as when requests were denied completely and when treatment was implemented by parents