European Journal of Behavior Analysis
ISSN: 1502-1149 (Print) 2377-729X (Online) Journal homepage: http://www.tandfonline.com/loi/rejo20
Using Brief Functional Assessments to Identify Specific Contexts for Problem Behavior Maintained by Positive and Negative Reinforcement Mark F. O’Reilly, David M. Richman, Giulio Lancioni, John Hillery, Steve Lindauer, Kim Crosland & Claire Lacey To cite this article: Mark F. O’Reilly, David M. Richman, Giulio Lancioni, John Hillery, Steve Lindauer, Kim Crosland & Claire Lacey (2000) Using Brief Functional Assessments to Identify Specific Contexts for Problem Behavior Maintained by Positive and Negative Reinforcement, European Journal of Behavior Analysis, 1:2, 135-142 To link to this article: http://dx.doi.org/10.1080/15021149.2000.11434164
Published online: 10 Jun 2000.
Submit your article to this journal
Article views: 1
View related articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=rejo20 Download by: [David M. Richman]
Date: 04 January 2016, At: 13:57
EUROPEAN JOURNAL OF BEHAVIOR ANALYSIS
2000, 1, 135 - 142
VOLUME 1, NUMBER 2 (WINTER 2000)135
Using Brief Functional Assessments to Identify Specific Contexts for Problem Behavior Maintained by Positive and Negative Reinforcement
Downloaded by [David M. Richman] at 13:57 04 January 2016
Mark F. O’Reilly National University of Ireland, Dublin
David M. Richman University of Kansas Medical Center
Giulio Lancioni University of Leiden
John Hillery National University of Ireland, Dublin
Steve Lindauer and Kim Crosland University of Kansas
Claire Lacey National University of Ireland, Dublin
We examined the use of brief outpatient functional assessment techniques to identify idiosyncratic discriminative stimuli for problem behavior maintained by positive and negative reinforcement in the form of access to tangible items and escape from specific academic activities. Two children participated in the assessment. Interviews with the parents prior to the functional assessment revealed that problem behavior occurred under very specific stimulus conditions. These specific stimulus conditions were incorporated within the outpatient functional assessment. The results of the functional assessments showed that problem behavior occurred almost exclusively during those assessment conditions that included the idiosyncratic stimuli identified in the prior interviews. The implications of these results for conducting brief outpatient functional assessments were discussed. DESCRIPTORS: Functional Assessment, Autism, Romanian Orphans, Problem Behavior
lem behavior such as self-injury and aggression with persons with special needs (Carr, Levin, McConnachie, Carlson, Kemp, &
Over the last several years researchers have begun to identify a number of core variables that seem to influence the probability of prob135
Downloaded by [David M. Richman] at 13:57 04 January 2016
136
M. F. O’Reilly, D. M. Richman, G. Lancioni, J. Hillery, S. Lindauer, K. Crosland and C. Lacey
Smith, 1994; Reichle & Wacker, 1993). Problem behavior can serve a communicative purpose in particular social contexts (Carr, 1977). For example, a person may engage in aggression towards self or others in order to access attention and/or tangible stimuli from others when that person is relatively deprived of such stimuli (Lovaas & Simmons, 1969; Vollmer, Marcus, Ringdahl, & Roane, 1995). Persons may also engage in problem behavior in order to avoid or escape various task demands or social contexts which they find to be aversive at that particular point in time (Taylor & Carr, 1992; Weeks & Gaylord-Ross, 1981). Other individuals may display problem behavior irrespective of social context. Such behavior seems to be evoked and maintained by private biological conditions (Cataldo & Harris, 1982; O’Reilly, 1997). Finally, problem behavior may be influenced by a combination of the above social and biological factors (Kennedy & Meyer, 1996; O’Reilly, 1995). Several clinical assessment methods have been used to examine the controlling factors for problem behavior for individuals with special needs. These clinical assessment methods include interviews, descriptive observational assessments, and experimental functional analysis techniques (O’Neill, Horner, Albin, Storey, & Sprague, 1990; Iwata, Dorsey, Slifer, Bauman, & Richman, 1982/1994). Interviews with caregivers and descriptive observational assessments can provide hypotheses regarding the controlling variables while experimental functional analyses provide a causal analysis of those hypothesized variables (Iwata, Vollmer, & Zarcone, 1990; Leslie & O’Reilly, 1999). Experimental functional analysis techniques typically involve repeatedly exposing the participant to a series of social conditions that are designed to identify the social function of problem behavior. In one condition the participant is ignored unless they engage in problem behavior at which point the therapist attends to the person. This condition examines whether behavior is maintained by attention. In another condition preferred tangible items (e.g., toys) are made available con-
tingent upon problem behavior which examines whether the behavior is maintained by access to such stimuli. In a third condition the participant is presented with difficult tasks which are removed contingent upon problem behavior. This condition examines whether the person engages in the behavior to escape from demanding tasks. In a final condition the participant is observed while he or she is alone to examine if the behavior occurs independent of social stimulation. A substantial amount of research has now demonstrated that experimental functional analysis protocols are highly effective and efficient methods for identifying contingencies that currently maintain problem behavior and, subsequently, in guiding treatment selection (Derby, Wacker, Sasso, Steege, Northup, Cigrand, & Asmus, 1992; Iwata, Pace, Dorsey, et al., 1994). Derby et al., (1992) summarized data from 79 individuals who were assessed in an outpatient clinic using the functional analysis conditions outlined above. In this sample, 63% of the participants displayed problem behavior during the assessment and a distinct maintaining contingency was identified for 74% of this group. In an epidemiological analysis of 152 individuals who exhibited self-injury Iwata et al., (1994) reported that 27% and 38.1% of this sample exhibited self-injury that was sensitive to positive reinforcement in the form of attention or negative reinforcement in the form of escape from demands respectively. While the overall results of experimental functional analysis protocols are positive, there remains a substantial subgroup of individuals for which such procedures do not reveal maintaining contingencies. This is particularly true with brief experimental analyses (i.e., lasting approximately 90 mins) that are conducted in outclinic settings. For example, in the Derby et al., (1992) evaluation 27% of individuals did not display any problem behavior during the functional analysis assessment conditions. The failure of such brief assessment protocol to identify maintaining contingencies with certain individuals may be due to the specificity or idiosyncratic nature of environmental stimuli that evoke and maintain problem be-
Downloaded by [David M. Richman] at 13:57 04 January 2016
Brief Functional Assessments havior for those individuals (Carr, Yarbrough, & Langdon, 1997; O’Reilly & Carey, 1996; O’Reilly, Lancioni, King, Lally, & Nic Dhomhnaill, 2000; Taylor, Sisson, McKelvey, & Trefelner, 1993). Traditional functional analysis conditions (described earlier) can identify a general relationship between problem behavior and environmental conditions (e.g., problem behavior may be differentially sensitive to attention or escape). However, when problem behavior is under control of specific idiosyncratic stimuli, it will be imperative to incorporate the idiosyncratic stimuli into assessment conditions in order to experimentally assess the maintaining contingencies for the individual’s problem behavior. Problem behavior may therefore be maintained by positive or negative reinforcement but only in the presence of specific discriminative stimuli for some individuals. It seems essential to identify such idiosyncratic stimuli and incorporate these stimuli within functional analysis conditions in order to produce valid assessment outcomes. In the present study we conducted brief functional analysis assessments with two children who engaged in problem behavior. Method Settings, Participants, and Target Behaviors
Two boys with special needs who exhibited problem behavior participated in the study. Both individuals were referred to a pediatric outpatient clinic at the National University of Ireland (Shawn) or the University of Kansas Medical Center (Mike) which provide outpatient assessment and treatment planning services for persons with special needs who exhibit problem behavior. Shawn, now 10 years, was adopted from a Romanian orphanage when he was 3 years old. He was of average ability and attended a local public school. He lived in a middle-class home with his adoptive parents and an older sibling. Mike was a 10-year-old with a diagnosis of autism and moderate mental retardation. He was nonvocal but could use picture schedules to help guide a limited number of regular daily
137
interactions. He could follow simple 2 to 3 step directions. Mike lived at home with his parents and attended a self-contained classroom in a public school. Shawn was referred because he was reported to engage in problem behavior at school. Problem behavior was described as noncompliance when presented with tasks. This was defined as refusal to perform tasks when instructed to do so by an adult. When given an instruction Shawn would typically turn his head in the opposite direction of the adult and fold his arms. When instructions were repeated he would shout obscenities and continue to refuse to perform. On other occasions he would push materials out of his immediate reach. Mike engaged in several forms of problem behavior including: hand biting, defined as bringing his hand up to his mouth and clamping his mouth around the soft tissue of the back of his hand; aggression, defined as pinching, scratching, or striking his parents; property destruction, defined as throwing toys or stepping on toys. General Procedures
The parents of each participant implemented a series of analogue social conditions derived from Iwata, Dorsey, Slifer, Bauman, & Richman, 1982/1994 during the outpatient assessment. Each session of these analogue social conditions lasted 5 min and the analogue sessions were repeated in a multielement treatment design during the assessment. The analogue social conditions were designed to empirically examine the operant function of problem behavior. Immediately prior to each analogue condition parents were instructed on how to conduct the session. The parents implemented all analogue sessions. There was approximately a 1 to 2 minute break between each session that was used to instruct parents on activities for the next session. Analogue analysis conditions were individually tailored to each participant based on a structured phone interview with the parents prior to the assessment. For example, the interview indicated that Shawn engaged in problem behavior almost exclusively when he was presented with any form of maths curriculum. Mike’s mother
Downloaded by [David M. Richman] at 13:57 04 January 2016
138
M. F. O’Reilly, D. M. Richman, G. Lancioni, J. Hillery, S. Lindauer, K. Crosland and C. Lacey
reported that problem behavior occurred most frequently when he was restricted from having access to string and string-like items or when he was restricted from engaging in specific preferred activities such as going outside to play. This information was therefore used to formulate specific assessment conditions for the participants (see below). Therefore there were differences in the outpatient assessment conditions for both children based on the interview assessment results. A brief description of each of the analogue assessment conditions follows. Attention. In the attention condition the parent remained approximately 3 m from the participant. There were materials such as books or toys available but no specific activities or tasks were provided. No other individuals were present in the room. The parents did not attend to the participant (e.g., read the newspaper or interacted with one another). Participants were ignored unless they engaged in problem behavior at which point one or both parents interacted with them for approximately 10 s. The parents then returned to their respective activities. This condition was used to assess whether problem behavior was sensitive to positive reinforcement in the form of attention. Demand. In this condition Shawn and Mike were presented with instructional tasks that were selected from their current educational curriculum. For Shawn, the instructional tasks in this demand condition (e.g., English writing tasks) were not the instructional tasks that were reported by parents to be associated with problem behavior (see Idiosyncratic Demands section below). The tasks were presented continuously throughout the assessment unless problem behavior occurred. Contingent upon problem behavior the parent was instructed to remove the task and move away from the participant for a minimum of 10 s or until the problem behavior stopped, at which point the task was to be immediately reinstated. The interactions of the parents were limited to instructional prompts and praise for correct responding (i.e., no informal interactions occurred). This condition was used to
assess whether problem behavior was sensitive to negative reinforcement in the form of escape from demanding situations. Idiosyncratic Demand. This condition was implemented with Shawn only. The results of the structured phone interview indicated that Shawn’s noncompliance occurred almost exclusively during maths instruction at school. Math problems from Shawn’s current school curriculum were presented to him during this condition. All other aspects of the idiosyncratic demand condition were identical to the demand condition described above. Tangible. This condition was implemented with Mike only based on the information from the structured interview. Mike interacted with his mother with a wide variety of toys. After Mike had played with a toy for 20–30 s his mother restricted access to that toy and told him that she had to put the toy away for now. Mike’s mother then placed the toy on a shelf out of Mike’s reach and he was only provided access to that toy contingent on problem behavior. Mike was then allowed to play with any toy in the room, and once again, if Mike played with a toy for at least 20-30 s, his mother repeated the procedures mentioned previously. Idiosyncratic Tangible. Again, this condition was only implemented with Mike. The results of the structured phone interview indicated that Mike’s problem behavior was primarily maintained by access to string and string-like items with which he typically engaged in stereotypic behavior (i.e., waving the string back and for the in front of his eyes). At the beginning of the session Mike was allowed access to a piece of string. Mike and his mother interacted until Mike had played with the string for 20-30 s at which point Mike’s mother removed the string. String was again made available contingent on problem behavior. All toys that were available during the tangible condition (see above) were also in the assessment room during this condition. Free Play. In the free play condition participants were involved in one-to-one play interactions with age-appropriate toys. Praise (e.g., “Good job playing with the car!”) was delivered continuously and toys were freely
Brief Functional Assessments available during this condition. All problem behavior was ignored or blocked and ignored (i.e., Mike’s aggressive behavior). The play condition served as a control condition as attention and tangible items were noncontingently available and demanding tasks were not presented.
139
occurred during each of the idiosyncratic demand sessions (mean, 56%; range, 37% to 66%).
For Shawn, observations were conducted using the videotapes of each assessment. The first author acted as primary observer. Problem behavior was recorded using a 10 s partial interval procedure. A second observer conducted reliability observations on approximately 40% of all sessions across all experimental conditions. The second observer independently viewed the videotape of assessment sessions. Interobserver agreement on occurrence of the target behaviors was calculated by dividing the number of agreements by the number of agreements plus disagreements and multiplying by 100%. Mean agreement was 93% (range, 77% to 100%). The frequency of target behaviors was recorded during each assessment session with Mike using a count within 10 s partial interval recording system (i.e., the frequency of problem behavior was scored within each 10 s interval). Two observers simultaneously but independently observed the target behaviors during 38% of all sessions across all experimental conditions. Agreement coefficients were calculated by dividing each session into 10 s intervals and dividing the number of exact agreements on occurrence of behavior by the sum of agreements plus disagreements multiplied by 100%. Mean exact agreement was 86% (range, 50% to 100%). Results The percentage of intervals of problem behavior under the different assessment conditions are presented for Shawn in Figure 1. No problem behavior occurred during the attention and free play conditions. Problem behavior occurred during one of the demand sessions (13%). High levels of problem behavior
Figure 1. Percentage of intervals of problem behavior for Shawn during functional analysis sessions.
The results of Mike’s functional analysis are presented in Figure 2. Very low rates of problem behavior occurred during the traditional functional analysis conditions. However, Mike engaged in relatively high and variable rates of problem behavior (mean, 1.65 per min; range. 0 to 2.3 per min) when he was exposed to the tangible condition that incorporated the idiosyncratic stimuli identified as highly correlated with problem behavior during the pre-functional analysis interview. Thus, the results of the brief functional analysis indicated that Mike’s problem behavior was maintained, at least in part, by contingent access to tangible items that he could engage in stereotypy.
2,5
Idiosyncratic Tangible Responses Per Minute of Problem Behavior
Downloaded by [David M. Richman] at 13:57 04 January 2016
Observation Procedures and Interobserver Reliability
2
1,5
1
Free Play
Mike
0,5
Social Attention
Tangible
Escape
0 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
Sessions
Figure 2. Rate of problem behavior for Mike during functional analysis sessions.
140
M. F. O’Reilly, D. M. Richman, G. Lancioni, J. Hillery, S. Lindauer, K. Crosland and C. Lacey
Downloaded by [David M. Richman] at 13:57 04 January 2016
Discussion The goal of this study was to examine whether brief functional analysis methods could be adapted to examine the influence of idiosyncratic stimulus conditions on problem behavior. The results of the study show that it is possible to tailor functional analysis assessment conditions based on prior interviews with parents. Parents of both participants indicated that problem behavior was more likely in the presence of specific academic demands (Shawn) and tangible items (Mike). The functional analysis revealed that problem behavior was maintained by escape during maths instruction for Shawn and by access to string for Mike. Participants did not engage in significant amounts of problem behavior under traditional functional analysis conditions that are designed to assess if problem behavior is sensitive to positive and negative reinforcement. This is very important because without incorporating idiosyncratic stimuli into the functional analysis, the assessment results would have been interpreted as inconclusive or undifferentiated. This would have greatly limited the investigator’s ability to provide specific treatment recommendations matched to the function of participants’ problem behavior. The brief functional analysis methodology can be a robust procedure for identifying maintaining contingencies of problem behavior and selecting successful treatments (Wacker, Steege, Northup, Reimers, Berg, & Sasso, 1990). Typically, these brief analyses have been conducted using traditional functional analysis conditions. The results of this investigation demonstrate that such traditional functional analysis conditions may not reveal maintaining contingencies with some cases. The power of such brief functional analysis techniques might be enhanced through incorporating information from prior interviews with caregivers into the assessment conditions. Incorporating such information about idiosyncratic stimuli into the assessment may enhance the validity of the assessment and the subsequent effectiveness of the treatment with some individuals. For ex-
ample, Mike engaged in very little problem or stereotypic behavior during the traditional functional analysis conditions, and without conducting the idiosyncratic tangible condition, we would not have identified that Mike’s problem behaviors are, at least in part, maintained by gaining and maintaining access to tangible items so that he can engage in stereotypic string play. Knowledge of this information allowed the investigators to tailor a treatment package for Mike that addressed his problem behavior related to gaining access to preferred items (i.e., string or string-like items) to engage in stereotypy. One of the advantages of brief functional analysis is the ease of implementation of this technique. It takes a short period of time to conduct and can produce valuable information regarding maintaining contingencies for problem behavior (Derby et al., 1992). Incorporating an analysis of idiosyncratic stimuli into a brief functional analysis assessment need not necessarily make such assessments more onerous. In this study we identified the idiosyncratic stimuli prior to the functional analysis using a brief structured phone interview with the parents. An additional assessment condition was then devised based on this information and subsequently evaluated during the functional analysis. This procedure may increase the frequency in which the brief functional analysis is effective in evoking and documenting the maintaining contingencies for problem behavior during brief outpatient evaluations. A limitation of this study is that it was conducted with only two participants so the generality of the findings is limited. These results do however support previous research which demonstrated that idiosyncratic stimuli can affect the outcomes of functional analysis assessments (Carr et al., 1997; O’Reilly, et al., 2000; Taylor et al., 1993). Future research should continue to evaluate the effects of idiosyncratic stimuli on problem behavior and examine ways of incorporating such information into functional analysis assessment methods in order to increase the effectiveness and efficiency of brief functional analyses of problem behavior.
Brief Functional Assessments
Downloaded by [David M. Richman] at 13:57 04 January 2016
References Carr, E. G. (1977). The motivation of selfinjurious behavior: A review of some hypotheses. Psychological Bulletin, 84, 800816. Carr, E. G., Levin, L., McConnachie, G., Carlson, J., Kemp, D. C., & Smith, C. E. (1994). Communication-based intervention for problem behavior : A user’s guide for producing positive change. Baltimore: Paul H. Brookes. Carr, E. G., Yarbrough, S. C., & Langdon, N. A. (1997). Effects of idiosyncratic stimulus variables on functional analysis outcomes. Journal of Applied Behavior Analysis, 30, 673-686. Cataldo, M. F., & Harris, J. (1982). The biological basis of self-injury in the mentally retarded. Analysis and Intervention in Developmental Disabilities, 2, 21-39. Derby, K. M., Wacker, D. P., Sasso, G., Steege, M., Northup, J., Cigrand, K., & Asmus, J. (1992). Brief functional assessment techniques to evaluate aberrant behavior in an outpatient clinic: A summary of 79 cases. Journal of Applied Behavior Analysis, 25, 713-721. Iwata, B. A., Dorsey, M. F., Slifer, K. J., Bauman, K. E., & Richman, G. S. (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). Iwata, B. A., Pace, G. M., Dorsey, M. F., Zarcone, J. R., Vollmer, T. R., Smith, R. G., Rodgers, T. A., Lerman, D. C., Shore, B. A., Mazaleski, J. L., Goh, H., Cowdery, G. E., Kalsher, M. J., McCosh, K. C., & Willis, K. D. (1994). The functions of selfinjurious behavior: An experimental-epidemiological analysis. Journal of Applied Behavior Analysis, 27, 215-240. Iwata, B. A., Vollmer, T. R., & Zarcone, J. R. (1990). The experimental (functional) analysis of behavior disorders: Methodology, applications, and limitations. In A. Repp & N. Singh (Eds.), Perspectives on the
141
use of nonaversive and aversive interventions for persons with developmental disabilities (pp. 301-330). Sycamore, Il: Sycamore. Kennedy, C. H., & Meyer, K. A. (1996). Sleep deprivation, allergy symptoms, and negatively reinforced problem behavior. Journal of Applied Behavior Analysis, 29, 133135. Leslie, J. C., & O’Reilly, M. F. (1999). Behavior analysis: Foundations and applications to psychology. Amsterdam: Harwood Academic Publishers. Lovaas, O. I., & Simmons, J. Q. (1969). Manipulation of self-destruction in three retarded children. Journal of Applied Behavior Analysis, 2, 143-157. O’Neill, R. E., Horner, R. H., Albin, R. W., Storey, K., & Sprague, J. R. (1990). Functional analysis of problem behavior : A practical assessment guide. Sycamore, IL: Sycamore. O’Reilly, M. F. (1995). Functional analysis and treatment of escape-maintained aggression correlated with sleep deprivation. Journal of Applied Behavior Analysis, 28, 225-226. O’Reilly, M. F. (1997). Functional analysis of episodic self-injury correlated with recurrent otitis media. Journal of Applied Behavior Analysis, 30, 165-167. O’Reilly, M. F., & Carey, Y. (1996). A preliminary analysis of the effects of prior classroom conditions on performance under analogue analysis conditions. Journal of Applied Behavior Analysis, 29, 581-584. O’Reilly, M.F., Lancioni, G., King, L., Lally, G., & Nic Dhomhnaill, O. (2000). Using brief assessments to evaluate aberrant behavior maintained by attention. Journal of Applied Behavior Analysis, 33, 109-112. Reichle, J. & Wacker, D. P. (1993). Communicative alternatives to challenging behavior : Integrating functional assessment and intervention strategies. Baltimore: Paul H. Brookes. Taylor, J. C., & Carr, E. G. (1992). Severe problem behaviors related to social interaction: I. Attention and social avoidance. Behavior Modification, 16, 305-335.
Downloaded by [David M. Richman] at 13:57 04 January 2016
142
M. F. O’Reilly, D. M. Richman, G. Lancioni, J. Hillery, S. Lindauer, K. Crosland and C. Lacey
Taylor, J. C., Sisson, J. L., McKelvey, J. L., & Trefelner, M. F. (1993). Situation specificity in attention-seeking problem behavior. Behavior Modification, 17, 474-497. Vollmer, T. R., Marcus, B. A., Ringdahl, J. E., & Roane, H. S. (1995). Progressing from brief assessments to extended experimental analyses in the evaluation of aberrant behavior. Journal of Applied Behavior Analysis, 28, 561-576. Wacker, D. P., Steege, M., Northup, J., Reimers, T., Berg, W., & Sasso, G. (1990). Use of functional analysis and acceptability measures to assess and treat severe behavior problems: An outpatient clinic model. In A. Repp & N. Singh (Eds.), Perspectives on the use of nonaversive and aversive interventions for persons with developmental disabilities (pp. 349-359). Sycamore, Il: Sycamore. Weeks, M., & Gaylord-Ross, R. (1981). Task difficulty and aberrant behavior in severely handicapped students. Journal of Applied Behavior Analysis, 14, 449-463.
Author Notes
Copies of the structured phone interview protocols are available upon request. Correspondence should be addressed to: Mark O’Reilly, Ph.D., Department of Psychology, National University of Ireland, Dublin, Belfield, Dublin 4, IRELAND. Corresponding Author:
Mark O’Reilly, Ph.D. Department of Psychology National University of Ireland, Dublin Belfield, Dublin 4, IRELAND Phone and Fax: 35345483615 E mail:
[email protected]
