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Examination of an antecedent communication intervention to reduce tangibly maintained challenging behavior: A controlled analog analysis
Research in Developmental Disabilities 33 (2012) 1462–1468
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Research in Developmental Disabilities
Examination of an antecedent communication intervention to reduce tangibly maintained challenging behavior: A controlled analog analysis Mark O’Reilly a,*, Christina Fragale a, Summer Gainey a, Soyeon Kang a, Heather Koch a, Jennifer Shubert a, Farah El Zein a, Deanna Longino a, Moon Chung a, Ziwei Xu a, Pamela White a, Russell Lang b, Tonya Davis c, Mandy Rispoli d, Giulio Lancioni e, Robert Didden f, Olive Healy g, Deborah Kagohara h, Larah van der Meer h, Jeff Sigafoos h a
The University of Texas at Austin, USA Texas State University-San Marcos, USA c Baylor University, USA d Texas A&M University, College Station, USA e University of Bari, Italy f Radbound University, The Netherlands g University College Galway, Ireland h Victoria University of Wellington, New Zealand b
A R T I C L E I N F O
A B S T R A C T
Article history: Received 7 March 2012 Accepted 8 March 2012 Available online 26 April 2012
We examined the influence of an antecedent communication intervention on challenging behavior for three students with developmental disorders. Students were taught to request tangible items that were identified as reinforcers for challenging behavior in a prior functional analysis. Individual participant multielement and reversal designs were used to compare the effects of the antecedent communication intervention versus a no antecedent communication intervention condition. Immediately following the antecedent manipulations students were exposed to the tangible condition of the functional analysis. Results indicate that the antecedent communication intervention reduced challenging behavior in the subsequent tangible test condition for all three students. The importance of examining antecedent interventions to treat challenging behavior from a function analytic perspective is discussed. ß 2012 Elsevier Ltd. All rights reserved.
Keywords: Challenging behavior Functional analysis Motivating operations Communication Developmental disorder
Despite the considerable amount of research effort dedicated to the assessment and treatment of aberrant behavior with individuals with developmental disabilities such behaviors continue to be a major concern for clinicians, support staff, and families (Emerson & Einfeld, 2011). Aberrant behavior such as self-injury, aggression, and property destruction can be so severe as to require clinical intervention with as many as 15% of this population (Sigafoos, Arthur, & O’Reilly, 2003). Subgroups of this population, such as those with autism spectrum disorders or severe multiple disabilities may display higher rates of clinically significant aberrant behavior (Matson et al., 2011; Poppes, van der Putten, & Vlaskamp, 2010). Research on the assessment and treatment of aberrant behavior therefore remains a priority with this population (Emerson & Einfeld, 2011). Behavioral interventions designed to treat aberrant behavior with this population can be broadly classed into two general categories – consequence and antecedent based. Contemporary consequence-based strategies typically involve
* Corresponding author at: Department of Special Education, 1 University Station D5300, The University of Texas at Austin, Austin, TX 78712, USA. E-mail address: [email protected] (M. O’Reilly). 0891-4222/$ – see front matter ß 2012 Elsevier Ltd. All rights reserved. doi:10.1016/j.ridd.2012.03.017
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manipulating reinforcement contingencies to reduce aberrant behavior and increase appropriate alternative behavior (Kahng, Iwata, & Lewin, 2002). Consequence-based interventions are typically preceded by a functional assessment designed to identify the consequences maintaining challenging behavior (e.g., Iwata, Dorsey, Slifer, Bauman, & Richman, 1994; Paclawskyj, Matson, Rush, Smalls, & Vollmer, 2000). Interventions are then tailored to the consequences identified as maintaining challenging behavior during the functional assessment. An example of such a consequence-based intervention is functional communication training (FCT; Carr & Durand, 1985). In essence FCT involves identifying the consequences maintaining aberrant behavior and then teaching the person alternative appropriate responses to access those same consequences. During FCT, aberrant behavior is typically placed on extinction, while the new communication responses are reinforced on an FR1 schedule. This differential reinforcement is intended to increase the efficiency of the new communication response and decrease the probability of aberrant behavior. Antecedent-based interventions, in contrast, include a series of strategies that are implemented prior to aberrant behavior that reduce the probability of this behavior occurring (Luiselli, 2006). Some of these strategies include: modifying activities or routines (Mesibov, Browder, & Kirkland, 2002; O’Reilly, Sigafoos, Lancioni, Edrisinha, & Andrews, 2005; O’Reilly, Sigafoos, et al., 2006); involving students in making choices (Cannella, O’Reilly, & Lancioni, 2005); teaching communication and social skills (O’Reilly, Cannella, Sigafoos, & Lancioni, 2006). These interventions have been shown to be associated with reductions in aberrant behavior and are touted as a cornerstone of the positive behavioral support movement (Carr et al., 2002). In contrast to consequence-based interventions these antecedent-based strategies are not necessarily selected from, or tailored to, a prior functional assessment of the aberrant behavior. This is a critical issue because when antecedent interventions do work, it may nonetheless be unclear why they work and visa versa. In fact the rationale for the effectiveness of these antecedent interventions is sometimes couched in terms of enhancing the freedom and dignity of the person (i.e., positive behavior support). While these sentiments are laudable they do not enhance our scientific understanding of the functional properties of such antecedent interventions. A small but emerging body of research is beginning to examine the functional properties of antecedent interventions in the treatment of aberrant behavior with this population (Berg et al., 2000; McComas, Thompson, & Johnson, 2003; O’Reilly, Edrisinha, Sigafoos, Lancioni, Cannella, et al., 2007; O’Reilly, Lacey, & Lancioni, 2000; O’Reilly, Lancioni, & Emerson, 1999; O’Reilly, Richman, et al., 2000; O’Reilly et al., 2008, 2009; Roantree & Kennedy, 2006). This research differs from the previous work cited above in that it is driven by a systematic conceptual approach that examines the functional relations between antecedent variables and the discriminated operant (McGill, 1999). Within this conceptual system these antecedent interventions can be broadly classified as motivating operations (MOs) that influence the evocative effects of discriminative stimuli and alter the value of reinforcers for challenging behavior (Langthorne, McGill, & O’Reilly, 2007; Laraway, Snycerski, Michael, & Poling, 2003). This research on the functional properties of antecedent interventions to treat aberrant behavior can be classified into two generic strands: (a) clarifying the functional properties of these antecedent variables (e.g., Edrisinha, O’Reilly, Sigafoos, Lancioni, & Choi, 2011; O’Reilly, Cannella, et al., 2006; O’Reilly, Edrisinha, Sigafoos, Lancioni, Machalicek, et al., 2007; O’Reilly, Sigafoos, et al., 2006); and (b) examining the application of these variables in the treatment of aberrant behavior (e.g., Davis et al., 2009; Lang et al., 2010; Rispoli et al., 2011). These preliminary investigations on the use of MOs as antecedent interventions to treat aberrant behavior have produced positive results. For example, Rispoli et al. (2011) determined through prior functional analyses that aberrant behaviors (throwing objects, screaming) were maintained by access to tangible items for two young school children with autism. Prior to regular classroom activities (where these behaviors were problematic) the children were given continuous access to the identified tangible items (certain children’s books, coloring pens, etc.) until they began to reject them. This intervention appeared to produce a satiation effect, reducing the reinforcing value of these items. Subsequent to this access (satiation) intervention aberrant behavior was dramatically reduced during classroom activities. Lang et al. (2010) introduced a similar access (satiation) intervention to reduce aberrant behavior during play interventions for young children with autism. Unlike many other antecedent interventions the effects of this access (satiation) intervention can be understood in terms of how MOs enter into a functional relation with the discriminated operant. In other words we can understand the effects of this intervention within a scientific framework. That is, the access condition decreases the evocative effectiveness of the discriminative stimuli and the power of the reinforcing consequences for the targeted aberrant behaviors, thereby eliminating or reducing such behaviors. A vital next step in this body of research is to translate such effective MO treatment strategies in a manner that they are acceptable and capable of being integrated into regular routines and implemented by service providers such as teachers and parents. For example, while access (satiation) proved effective as an MO intervention in the studies cited above the intervention itself might not be manageable in many classrooms (e.g., allowing the child to have unlimited free access to tangibles items for up to 30 min). And even if such strategies were manageable in a classroom they might not be seen as acceptable to many teachers as the child is not being taught anything during this period. One possible way to enhance the acceptability/applicability of such an intervention might be to embed access (satiation) within the context of instructional programming. For example, if a child engages in aberrant behavior to access attention or tangible items then an MO intervention might include teaching the child to produce an appropriate communication response (FCT) to gain access to the reinforcer, then delivering copious access to the reinforcer during communication training. In this way the child is being taught a functional communication skill and receiving almost continuous access to the consequence maintaining aberrant behavior (MO intervention to produce satiation). Of course the efficacy of such an intervention is merely conjecture and requires empirical evidence. Such research should be conducted under tightly controlled
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experimental conditions initially to examine the effectiveness of this embedded MO intervention prior to testing its efficacy in applied contexts such as school settings. In the current study we examined the effectiveness of a communication intervention coupled with access to large amounts of the consequences maintaining aberrant behavior (MO) as an antecedent intervention with three children with developmental disabilities. Prior functional analyses indicated that aberrant behavior was maintained by access to tangible items for all three children. Aberrant behavior under the tangible condition of the functional analysis was compared immediately following the communication intervention versus no communication intervention. This analysis was conducted to determine whether the communication intervention (incorporating access to the tangible items maintaining aberrant behavior) would function as a MO to reduce tangibly maintained aberrant behavior. 1. Methods 1.1. Participants and settings Three students (Matthew, Mark, and Luke) aged 5, 9, and 5 years respectively, participated in the study. All three students were diagnosed with a variety of developmental disorders including autism. Matthew, Mark, and Luke scored 36.5, 46, and 32.5 on the Childhood Autism Rating Scale (CARS; Schopler, Reichler, & Renner, 1988) respectively indicating that they functioned in the moderate to severe range of autism. Teachers reported that Matthew rarely spoke but could follow simple two-step directions. Often he would tend to perseverate on sounds, verbally echoing them. Mark’s teachers reported that he could follow simple one-step directions and adhere to school routines if given a picture schedule. He communicated using one-word approximations or by leading an adult by the hand. Luke could spontaneously request using phrases and could follow multiple-step directions according to his teachers. He also tended to recite phrases from preferred television shows and movies. Each of these three students spent a large proportion of their school day engrossed with particular items (Matthew – computer toy; Mark – Magna Doodle; Luke – iPad). Engagement with these items was predominantly nonfunctional (e.g., Mark repeatedly drew approximations of four letters). Aberrant behavior occurred (described below) when teachers attempted to redirect the students from these items to other classroom activities. Matthew and Luke attended private schools that served children with language and developmental delays. Mark attended a public school where he received special education services in a self-contained classroom. All assessments and interventions reported in this study were conducted in an empty classroom in each of the students’ respective schools. 1.2. Target behaviors and response measurement Target aberrant behaviors for each student were identified through interview with the teachers followed by informal observation of the students in their classrooms by the second author (C. Fragale). Target behaviors for Matthew and Luke included elopement, flopping, and yelling. Elopement was defined as moving more that 3 ft away from the table. Flopping was defined as throwing the body on the ground with refusal or resistance to prompts to stand up. Yelling was defined as highpitched utterances above the conversational level (e.g., ‘‘eeeee’’ and ‘‘ahhh’’ for Matthew and ‘‘my iPad’’, ‘‘noooo’’, or ‘‘help’’ for Luke). Target behaviors for Mark included head slaps and biting. Head slaps was defined as repeatedly hitting the head with the palm of one or both hands three or more times with less than 3 s between hits. Biting was defined as teeth on his skin or attempts to bite others (moving toward another person with an open mouth). Head slaps or biting were relatively mild behaviors and did not cause any bruising. All sessions of the functional analysis and sessions following the antecedent communication intervention were videotaped and aberrant behavior was assessed using a 10 s partial interval recording system. 1.3. Experimental design Individual participant multielement and ABAB designs (Barlow, Nock, & Hersen, 2009) were used to evaluate maintaining contingencies (see Section 1.4) and the effects of the MO intervention (see Section 1.5) on aberrant behavior. 1.4. Functional analysis A functional analysis was conducted for each student to determine contingencies maintaining aberrant behavior. The protocol used in the functional analysis was similar to that described by Iwata et al. (1982/1994). Each student was exposed to five 10-min sessions of each of four conditions in a multielement design format. The four conditions included attention, demand, tangible, and play. During the tangible condition students gained access to their favorite classroom items described above (e.g., iPad for Luke) contingent upon aberrant behavior. That is, when the student yelled, eloped, or flopped etc. they received 10 s access to the favorite item, at which point the item was removed and then reintroduced for a further 10 s contingent upon another occurrence of aberrant behavior. In the attention condition students received 10 s of attention contingent upon challenging behavior but were otherwise ignored by the therapist. During the demand condition instructional tasks were presented that the students had difficulty completing. Tasks were removed for 10 s contingent upon
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challenging behavior and were then re-introduced. In the play condition preferred toys (identified by the teachers and not the same items used in the tangible test condition) were available, no tasks were presented, and the therapist interacted in a pleasant manner with the student on an FT 10 s schedule. 1.5. Evaluation of antecedent communication intervention Students were exposed to an antecedent communication versus no antecedent communication intervention in a multielement or reversal design format. Immediately following the antecedent conditions the students were again exposed to the tangible condition (one 10-min session) of the functional analysis. Aberrant behavior occurred predominantly in the tangible condition of the previous functional analysis for all students (see Section 2). Therefore the tangible condition was used as a test condition to examine the effects of the antecedent communication intervention on aberrant behavior in this phase of the study. 1.5.1. Antecedent communication intervention Each of the three students was taught to mand for the items associated with aberrant behavior while all aberrant behavior was ignored. A 0 s time delay was used to teach the targeted mand to Matthew (‘‘Can I have little computer?’’), Mark (‘‘Doodle?’’), and Luke (‘‘Can I have iPad?’’). The therapist presented the item and simultaneously stated the targeted mand. Once the student repeated the mand they were given immediate access to the item. The student then had access to the item for 30 s at which point it was removed and immediately represented by the therapist coupled with the targeted mand phrase. Each antecedent communication session consisted of 20 mand trials for Matthew and Luke. Matthew and Luke therefore had access to their preferred item for 10 min and 30 s during each antecedent communication intervention session. Mark received 30 mand trials during antecedent communication intervention sessions. Therefore Mark had access to his item for 15 min 30 s during the antecedent communication intervention sessions. Immediately following an antecedent communication intervention session, the students were then exposed to the tangible condition (one 10-min session) of the functional analysis. 1.5.2. No antecedent communication intervention In this condition students were involved in their typical classroom routines. Also, they did not have access to their preferred items (e.g., iPad) for at least 2 h prior to being exposed to the tangible condition (one 10-min session) of the functional analysis. 1.6. Reliability and procedural integrity Two independent observers simultaneously scored aberrant behavior (using the video recordings) on 33% of sessions of the functional analysis and antecedent communication intervention evaluation (the tangible sessions following the antecedent conditions) using a 10-s partial interval recording system. Interobserver agreement was calculated on an interval-by-interval basis by dividing the number of agreements (occurrence and nonoccurrence) by the total number of agreements plus disagreements in each session and multiplying by 100%. Mean agreement for aberrant behavior during the functional analyses was 96% (range, 83–100%), 97% (range, 93–100%), and 97.6% (range, 90–100%) for Matthew, Mark, and Luke, respectively. Mean agreement for aberrant behavior during the tangible sessions of the antecedent communication evaluation was 94% (range, 83–100%), 96.5% (range, 93–100%), and 97.8% (range, 93.1–100%) for Matthew, Mark, and Luke respectively. Procedural integrity was measured on 33% of opportunities of the functional analysis, antecedent communication intervention, and no antecedent communication intervention protocols. A task analysis of each of these protocols was developed. An independent observer then scored implementation of the functional analysis protocols and the antecedent treatment conditions using these task analyses. Procedural integrity was calculated by dividing the number of correct steps of the task analyses by the total number of steps and multiplying by 100%. Overall procedural integrity was 98%. 2. Results The results of the functional analyses for Matthew, Mark, and Luke are presented in Fig. 1. Aberrant behavior occurred predominantly within the tangible condition of the functional analysis for all three students. These results indicate that aberrant behavior was maintained by access to their preferred tangible items (small computer, Magna Doodle, and iPad) for the three students. The results of the antecedent communication intervention for Matthew, Mark, and Luke are presented in Fig. 2. Each data point in these graphs represents the percentage of intervals with aberrant behavior during a 10-min tangible session following either the antecedent communication intervention or the no antecedent communication condition. Aberrant behavior was relatively lower for all three students following the antecedent communication intervention (M = 13.6%, 7.1%, 1% of intervals for Matthew, Mark, and Luke, respectively). Aberrant behavior was relatively higher for the students following the no antecedent communication condition (M = 48.7%, 33.1%, 68.8% of intervals for Matthew, Mark, and Luke, respectively).
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Fig. 1. Percentage of intervals with aberrant behavior during attention, demand, tangible, and play conditions for Matthew (top panel), Mark (middle panel), and Luke (bottom panel).
3. Discussion In this study we demonstrated that an antecedent communication intervention incorporating access to identified reinforcers for challenging behavior was effective in reducing challenging behavior. During the first phase of the study we demonstrated that challenging behavior was primarily maintained by access to tangible items for the three students. In the second phase of the study we evaluated a communication intervention that included rich access to the reinforcers for challenging behavior identified in the prior functional analysis. The antecedent communication intervention reduced challenging behavior in the subsequent tangible test condition. Presession access to reinforcers for challenging behavior can act as an abolishing operation as demonstrated in this and previous research (e.g., Berg et al., 2000; McComas et al., 2003; O’Reilly et al., 2009; Rispoli et al., 2011). This current study extends the previous literature by demonstrating that presession access interventions can be successfully incorporated within a regular classroom instructional activity (such as a communication intervention). This study presents a methodology for the systematic examination of the functional properties of antecedent interventions for challenging behavior. Antecedent interventions are conceptualized as motivating operations – stimuli or conditions that alter the effect of discriminative stimuli and the value of reinforcing consequences. This conceptualization requires that we first isolate challenging behavior as a discriminated operant and then hold such experimental conditions constant while we systematically examine the influence of putative antecedent interventions on the discriminated operant. The analog functional analysis is designed to experimentally isolate challenging behavior as a discriminated operant. Analog functional analysis has been a critical methodological tool in the development of this recent body of research on motivating operations as antecedent interventions for challenging behavior (e.g., Lang et al., 2010; McComas et al., 2003).
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Fig. 2. Percentage of intervals with aberrant behavior during the tangible condition following the antecedent communication versus the no antecedent communication conditions for Matthew (top panel), Mark (middle panel), and Luke (bottom panel).
This study is part of a growing body of research based on a systematic understanding of how antecedent variables enter into a functional relationship with the discriminated operant (e.g., Langthorne et al., 2007; Laraway et al., 2003; McGill, 1999). As mentioned in the introduction, a substantial body of published literature has demonstrated the positive effects of various antecedent interventions on challenging behavior with individuals with developmental disabilities (Luiselli, 2006). However, a truly scientific understanding (functional analysis) of why many of these antecedent interventions are effective has not occurred. Until we examine how interventions such as modifying a student’s routines/schedules impact the effects of discriminative stimuli and the value of reinforcers for challenging behavior we are relegated to pseudoscientific explanations (e.g., empowerment, self-determination) for why these strategies work. The antecedent communication intervention reduced, but did not eliminate, challenging behavior for Matthew and Mark. This seems to be a relatively common finding with other studies that have examined presession access to reinforcers for challenging behavior (e.g., Lang et al., 2010; O’Reilly et al., 2008). Given these findings, such antecedent interventions should not be seen as a panacea in the treatment of challenging behavior. Rather, antecedent interventions might be most effective when combined with consequence-based interventions (e.g., FCT) in treatment. Future research might examine functionally derived combinations of treatments (antecedent and consequence based treatments) versus consequence only treatments on challenging behavior. For example, it may be the case that consequence-based strategies might be easier to implement if challenging behavior is initially reduced using antecedent-based strategies. This is the first study to incorporate a functionally derived antecedent intervention (presession access to tangibles) within a typical curricular activity (communication training). While the results of this intervention are consistent both within and across the three participants, these methods should be replicated across additional participants. Future research should also
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examine the effectiveness of incorporating presession access interventions into other components of the school routine (e.g., play, self-care, etc.). We used the tangible condition of the functional analysis as a test condition to examine the effects of the antecedent communication intervention on tangibly maintained challenging behavior. The tangible test condition is a tightly controlled experimental preparation and may not be indicative of the complexities present in a regular classroom environment following the antecedent intervention. Future research should test the applied veracity of this antecedent communication intervention by examining the effects on challenging behavior within regular classroom activities. References Barlow, D. H., Nock, M. K., & Hersen, M. (2009). Single case experimental designs: Strategies for studying behavior change (3rd ed.). Boston: Allyn & Bacon. Berg, W. K., Peck, S., Wacker, D. P., Harding, J., McComas, J., Richman, D., et al. (2000). 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Contents lists available at SciVerse ScienceDirect
Research in Developmental Disabilities
Examination of an antecedent communication intervention to reduce tangibly maintained challenging behavior: A controlled analog analysis Mark O’Reilly a,*, Christina Fragale a, Summer Gainey a, Soyeon Kang a, Heather Koch a, Jennifer Shubert a, Farah El Zein a, Deanna Longino a, Moon Chung a, Ziwei Xu a, Pamela White a, Russell Lang b, Tonya Davis c, Mandy Rispoli d, Giulio Lancioni e, Robert Didden f, Olive Healy g, Deborah Kagohara h, Larah van der Meer h, Jeff Sigafoos h a
The University of Texas at Austin, USA Texas State University-San Marcos, USA c Baylor University, USA d Texas A&M University, College Station, USA e University of Bari, Italy f Radbound University, The Netherlands g University College Galway, Ireland h Victoria University of Wellington, New Zealand b
A R T I C L E I N F O
A B S T R A C T
Article history: Received 7 March 2012 Accepted 8 March 2012 Available online 26 April 2012
We examined the influence of an antecedent communication intervention on challenging behavior for three students with developmental disorders. Students were taught to request tangible items that were identified as reinforcers for challenging behavior in a prior functional analysis. Individual participant multielement and reversal designs were used to compare the effects of the antecedent communication intervention versus a no antecedent communication intervention condition. Immediately following the antecedent manipulations students were exposed to the tangible condition of the functional analysis. Results indicate that the antecedent communication intervention reduced challenging behavior in the subsequent tangible test condition for all three students. The importance of examining antecedent interventions to treat challenging behavior from a function analytic perspective is discussed. ß 2012 Elsevier Ltd. All rights reserved.
Keywords: Challenging behavior Functional analysis Motivating operations Communication Developmental disorder
Despite the considerable amount of research effort dedicated to the assessment and treatment of aberrant behavior with individuals with developmental disabilities such behaviors continue to be a major concern for clinicians, support staff, and families (Emerson & Einfeld, 2011). Aberrant behavior such as self-injury, aggression, and property destruction can be so severe as to require clinical intervention with as many as 15% of this population (Sigafoos, Arthur, & O’Reilly, 2003). Subgroups of this population, such as those with autism spectrum disorders or severe multiple disabilities may display higher rates of clinically significant aberrant behavior (Matson et al., 2011; Poppes, van der Putten, & Vlaskamp, 2010). Research on the assessment and treatment of aberrant behavior therefore remains a priority with this population (Emerson & Einfeld, 2011). Behavioral interventions designed to treat aberrant behavior with this population can be broadly classed into two general categories – consequence and antecedent based. Contemporary consequence-based strategies typically involve
* Corresponding author at: Department of Special Education, 1 University Station D5300, The University of Texas at Austin, Austin, TX 78712, USA. E-mail address: [email protected] (M. O’Reilly). 0891-4222/$ – see front matter ß 2012 Elsevier Ltd. All rights reserved. doi:10.1016/j.ridd.2012.03.017
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manipulating reinforcement contingencies to reduce aberrant behavior and increase appropriate alternative behavior (Kahng, Iwata, & Lewin, 2002). Consequence-based interventions are typically preceded by a functional assessment designed to identify the consequences maintaining challenging behavior (e.g., Iwata, Dorsey, Slifer, Bauman, & Richman, 1994; Paclawskyj, Matson, Rush, Smalls, & Vollmer, 2000). Interventions are then tailored to the consequences identified as maintaining challenging behavior during the functional assessment. An example of such a consequence-based intervention is functional communication training (FCT; Carr & Durand, 1985). In essence FCT involves identifying the consequences maintaining aberrant behavior and then teaching the person alternative appropriate responses to access those same consequences. During FCT, aberrant behavior is typically placed on extinction, while the new communication responses are reinforced on an FR1 schedule. This differential reinforcement is intended to increase the efficiency of the new communication response and decrease the probability of aberrant behavior. Antecedent-based interventions, in contrast, include a series of strategies that are implemented prior to aberrant behavior that reduce the probability of this behavior occurring (Luiselli, 2006). Some of these strategies include: modifying activities or routines (Mesibov, Browder, & Kirkland, 2002; O’Reilly, Sigafoos, Lancioni, Edrisinha, & Andrews, 2005; O’Reilly, Sigafoos, et al., 2006); involving students in making choices (Cannella, O’Reilly, & Lancioni, 2005); teaching communication and social skills (O’Reilly, Cannella, Sigafoos, & Lancioni, 2006). These interventions have been shown to be associated with reductions in aberrant behavior and are touted as a cornerstone of the positive behavioral support movement (Carr et al., 2002). In contrast to consequence-based interventions these antecedent-based strategies are not necessarily selected from, or tailored to, a prior functional assessment of the aberrant behavior. This is a critical issue because when antecedent interventions do work, it may nonetheless be unclear why they work and visa versa. In fact the rationale for the effectiveness of these antecedent interventions is sometimes couched in terms of enhancing the freedom and dignity of the person (i.e., positive behavior support). While these sentiments are laudable they do not enhance our scientific understanding of the functional properties of such antecedent interventions. A small but emerging body of research is beginning to examine the functional properties of antecedent interventions in the treatment of aberrant behavior with this population (Berg et al., 2000; McComas, Thompson, & Johnson, 2003; O’Reilly, Edrisinha, Sigafoos, Lancioni, Cannella, et al., 2007; O’Reilly, Lacey, & Lancioni, 2000; O’Reilly, Lancioni, & Emerson, 1999; O’Reilly, Richman, et al., 2000; O’Reilly et al., 2008, 2009; Roantree & Kennedy, 2006). This research differs from the previous work cited above in that it is driven by a systematic conceptual approach that examines the functional relations between antecedent variables and the discriminated operant (McGill, 1999). Within this conceptual system these antecedent interventions can be broadly classified as motivating operations (MOs) that influence the evocative effects of discriminative stimuli and alter the value of reinforcers for challenging behavior (Langthorne, McGill, & O’Reilly, 2007; Laraway, Snycerski, Michael, & Poling, 2003). This research on the functional properties of antecedent interventions to treat aberrant behavior can be classified into two generic strands: (a) clarifying the functional properties of these antecedent variables (e.g., Edrisinha, O’Reilly, Sigafoos, Lancioni, & Choi, 2011; O’Reilly, Cannella, et al., 2006; O’Reilly, Edrisinha, Sigafoos, Lancioni, Machalicek, et al., 2007; O’Reilly, Sigafoos, et al., 2006); and (b) examining the application of these variables in the treatment of aberrant behavior (e.g., Davis et al., 2009; Lang et al., 2010; Rispoli et al., 2011). These preliminary investigations on the use of MOs as antecedent interventions to treat aberrant behavior have produced positive results. For example, Rispoli et al. (2011) determined through prior functional analyses that aberrant behaviors (throwing objects, screaming) were maintained by access to tangible items for two young school children with autism. Prior to regular classroom activities (where these behaviors were problematic) the children were given continuous access to the identified tangible items (certain children’s books, coloring pens, etc.) until they began to reject them. This intervention appeared to produce a satiation effect, reducing the reinforcing value of these items. Subsequent to this access (satiation) intervention aberrant behavior was dramatically reduced during classroom activities. Lang et al. (2010) introduced a similar access (satiation) intervention to reduce aberrant behavior during play interventions for young children with autism. Unlike many other antecedent interventions the effects of this access (satiation) intervention can be understood in terms of how MOs enter into a functional relation with the discriminated operant. In other words we can understand the effects of this intervention within a scientific framework. That is, the access condition decreases the evocative effectiveness of the discriminative stimuli and the power of the reinforcing consequences for the targeted aberrant behaviors, thereby eliminating or reducing such behaviors. A vital next step in this body of research is to translate such effective MO treatment strategies in a manner that they are acceptable and capable of being integrated into regular routines and implemented by service providers such as teachers and parents. For example, while access (satiation) proved effective as an MO intervention in the studies cited above the intervention itself might not be manageable in many classrooms (e.g., allowing the child to have unlimited free access to tangibles items for up to 30 min). And even if such strategies were manageable in a classroom they might not be seen as acceptable to many teachers as the child is not being taught anything during this period. One possible way to enhance the acceptability/applicability of such an intervention might be to embed access (satiation) within the context of instructional programming. For example, if a child engages in aberrant behavior to access attention or tangible items then an MO intervention might include teaching the child to produce an appropriate communication response (FCT) to gain access to the reinforcer, then delivering copious access to the reinforcer during communication training. In this way the child is being taught a functional communication skill and receiving almost continuous access to the consequence maintaining aberrant behavior (MO intervention to produce satiation). Of course the efficacy of such an intervention is merely conjecture and requires empirical evidence. Such research should be conducted under tightly controlled
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experimental conditions initially to examine the effectiveness of this embedded MO intervention prior to testing its efficacy in applied contexts such as school settings. In the current study we examined the effectiveness of a communication intervention coupled with access to large amounts of the consequences maintaining aberrant behavior (MO) as an antecedent intervention with three children with developmental disabilities. Prior functional analyses indicated that aberrant behavior was maintained by access to tangible items for all three children. Aberrant behavior under the tangible condition of the functional analysis was compared immediately following the communication intervention versus no communication intervention. This analysis was conducted to determine whether the communication intervention (incorporating access to the tangible items maintaining aberrant behavior) would function as a MO to reduce tangibly maintained aberrant behavior. 1. Methods 1.1. Participants and settings Three students (Matthew, Mark, and Luke) aged 5, 9, and 5 years respectively, participated in the study. All three students were diagnosed with a variety of developmental disorders including autism. Matthew, Mark, and Luke scored 36.5, 46, and 32.5 on the Childhood Autism Rating Scale (CARS; Schopler, Reichler, & Renner, 1988) respectively indicating that they functioned in the moderate to severe range of autism. Teachers reported that Matthew rarely spoke but could follow simple two-step directions. Often he would tend to perseverate on sounds, verbally echoing them. Mark’s teachers reported that he could follow simple one-step directions and adhere to school routines if given a picture schedule. He communicated using one-word approximations or by leading an adult by the hand. Luke could spontaneously request using phrases and could follow multiple-step directions according to his teachers. He also tended to recite phrases from preferred television shows and movies. Each of these three students spent a large proportion of their school day engrossed with particular items (Matthew – computer toy; Mark – Magna Doodle; Luke – iPad). Engagement with these items was predominantly nonfunctional (e.g., Mark repeatedly drew approximations of four letters). Aberrant behavior occurred (described below) when teachers attempted to redirect the students from these items to other classroom activities. Matthew and Luke attended private schools that served children with language and developmental delays. Mark attended a public school where he received special education services in a self-contained classroom. All assessments and interventions reported in this study were conducted in an empty classroom in each of the students’ respective schools. 1.2. Target behaviors and response measurement Target aberrant behaviors for each student were identified through interview with the teachers followed by informal observation of the students in their classrooms by the second author (C. Fragale). Target behaviors for Matthew and Luke included elopement, flopping, and yelling. Elopement was defined as moving more that 3 ft away from the table. Flopping was defined as throwing the body on the ground with refusal or resistance to prompts to stand up. Yelling was defined as highpitched utterances above the conversational level (e.g., ‘‘eeeee’’ and ‘‘ahhh’’ for Matthew and ‘‘my iPad’’, ‘‘noooo’’, or ‘‘help’’ for Luke). Target behaviors for Mark included head slaps and biting. Head slaps was defined as repeatedly hitting the head with the palm of one or both hands three or more times with less than 3 s between hits. Biting was defined as teeth on his skin or attempts to bite others (moving toward another person with an open mouth). Head slaps or biting were relatively mild behaviors and did not cause any bruising. All sessions of the functional analysis and sessions following the antecedent communication intervention were videotaped and aberrant behavior was assessed using a 10 s partial interval recording system. 1.3. Experimental design Individual participant multielement and ABAB designs (Barlow, Nock, & Hersen, 2009) were used to evaluate maintaining contingencies (see Section 1.4) and the effects of the MO intervention (see Section 1.5) on aberrant behavior. 1.4. Functional analysis A functional analysis was conducted for each student to determine contingencies maintaining aberrant behavior. The protocol used in the functional analysis was similar to that described by Iwata et al. (1982/1994). Each student was exposed to five 10-min sessions of each of four conditions in a multielement design format. The four conditions included attention, demand, tangible, and play. During the tangible condition students gained access to their favorite classroom items described above (e.g., iPad for Luke) contingent upon aberrant behavior. That is, when the student yelled, eloped, or flopped etc. they received 10 s access to the favorite item, at which point the item was removed and then reintroduced for a further 10 s contingent upon another occurrence of aberrant behavior. In the attention condition students received 10 s of attention contingent upon challenging behavior but were otherwise ignored by the therapist. During the demand condition instructional tasks were presented that the students had difficulty completing. Tasks were removed for 10 s contingent upon
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challenging behavior and were then re-introduced. In the play condition preferred toys (identified by the teachers and not the same items used in the tangible test condition) were available, no tasks were presented, and the therapist interacted in a pleasant manner with the student on an FT 10 s schedule. 1.5. Evaluation of antecedent communication intervention Students were exposed to an antecedent communication versus no antecedent communication intervention in a multielement or reversal design format. Immediately following the antecedent conditions the students were again exposed to the tangible condition (one 10-min session) of the functional analysis. Aberrant behavior occurred predominantly in the tangible condition of the previous functional analysis for all students (see Section 2). Therefore the tangible condition was used as a test condition to examine the effects of the antecedent communication intervention on aberrant behavior in this phase of the study. 1.5.1. Antecedent communication intervention Each of the three students was taught to mand for the items associated with aberrant behavior while all aberrant behavior was ignored. A 0 s time delay was used to teach the targeted mand to Matthew (‘‘Can I have little computer?’’), Mark (‘‘Doodle?’’), and Luke (‘‘Can I have iPad?’’). The therapist presented the item and simultaneously stated the targeted mand. Once the student repeated the mand they were given immediate access to the item. The student then had access to the item for 30 s at which point it was removed and immediately represented by the therapist coupled with the targeted mand phrase. Each antecedent communication session consisted of 20 mand trials for Matthew and Luke. Matthew and Luke therefore had access to their preferred item for 10 min and 30 s during each antecedent communication intervention session. Mark received 30 mand trials during antecedent communication intervention sessions. Therefore Mark had access to his item for 15 min 30 s during the antecedent communication intervention sessions. Immediately following an antecedent communication intervention session, the students were then exposed to the tangible condition (one 10-min session) of the functional analysis. 1.5.2. No antecedent communication intervention In this condition students were involved in their typical classroom routines. Also, they did not have access to their preferred items (e.g., iPad) for at least 2 h prior to being exposed to the tangible condition (one 10-min session) of the functional analysis. 1.6. Reliability and procedural integrity Two independent observers simultaneously scored aberrant behavior (using the video recordings) on 33% of sessions of the functional analysis and antecedent communication intervention evaluation (the tangible sessions following the antecedent conditions) using a 10-s partial interval recording system. Interobserver agreement was calculated on an interval-by-interval basis by dividing the number of agreements (occurrence and nonoccurrence) by the total number of agreements plus disagreements in each session and multiplying by 100%. Mean agreement for aberrant behavior during the functional analyses was 96% (range, 83–100%), 97% (range, 93–100%), and 97.6% (range, 90–100%) for Matthew, Mark, and Luke, respectively. Mean agreement for aberrant behavior during the tangible sessions of the antecedent communication evaluation was 94% (range, 83–100%), 96.5% (range, 93–100%), and 97.8% (range, 93.1–100%) for Matthew, Mark, and Luke respectively. Procedural integrity was measured on 33% of opportunities of the functional analysis, antecedent communication intervention, and no antecedent communication intervention protocols. A task analysis of each of these protocols was developed. An independent observer then scored implementation of the functional analysis protocols and the antecedent treatment conditions using these task analyses. Procedural integrity was calculated by dividing the number of correct steps of the task analyses by the total number of steps and multiplying by 100%. Overall procedural integrity was 98%. 2. Results The results of the functional analyses for Matthew, Mark, and Luke are presented in Fig. 1. Aberrant behavior occurred predominantly within the tangible condition of the functional analysis for all three students. These results indicate that aberrant behavior was maintained by access to their preferred tangible items (small computer, Magna Doodle, and iPad) for the three students. The results of the antecedent communication intervention for Matthew, Mark, and Luke are presented in Fig. 2. Each data point in these graphs represents the percentage of intervals with aberrant behavior during a 10-min tangible session following either the antecedent communication intervention or the no antecedent communication condition. Aberrant behavior was relatively lower for all three students following the antecedent communication intervention (M = 13.6%, 7.1%, 1% of intervals for Matthew, Mark, and Luke, respectively). Aberrant behavior was relatively higher for the students following the no antecedent communication condition (M = 48.7%, 33.1%, 68.8% of intervals for Matthew, Mark, and Luke, respectively).
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Fig. 1. Percentage of intervals with aberrant behavior during attention, demand, tangible, and play conditions for Matthew (top panel), Mark (middle panel), and Luke (bottom panel).
3. Discussion In this study we demonstrated that an antecedent communication intervention incorporating access to identified reinforcers for challenging behavior was effective in reducing challenging behavior. During the first phase of the study we demonstrated that challenging behavior was primarily maintained by access to tangible items for the three students. In the second phase of the study we evaluated a communication intervention that included rich access to the reinforcers for challenging behavior identified in the prior functional analysis. The antecedent communication intervention reduced challenging behavior in the subsequent tangible test condition. Presession access to reinforcers for challenging behavior can act as an abolishing operation as demonstrated in this and previous research (e.g., Berg et al., 2000; McComas et al., 2003; O’Reilly et al., 2009; Rispoli et al., 2011). This current study extends the previous literature by demonstrating that presession access interventions can be successfully incorporated within a regular classroom instructional activity (such as a communication intervention). This study presents a methodology for the systematic examination of the functional properties of antecedent interventions for challenging behavior. Antecedent interventions are conceptualized as motivating operations – stimuli or conditions that alter the effect of discriminative stimuli and the value of reinforcing consequences. This conceptualization requires that we first isolate challenging behavior as a discriminated operant and then hold such experimental conditions constant while we systematically examine the influence of putative antecedent interventions on the discriminated operant. The analog functional analysis is designed to experimentally isolate challenging behavior as a discriminated operant. Analog functional analysis has been a critical methodological tool in the development of this recent body of research on motivating operations as antecedent interventions for challenging behavior (e.g., Lang et al., 2010; McComas et al., 2003).
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Fig. 2. Percentage of intervals with aberrant behavior during the tangible condition following the antecedent communication versus the no antecedent communication conditions for Matthew (top panel), Mark (middle panel), and Luke (bottom panel).
This study is part of a growing body of research based on a systematic understanding of how antecedent variables enter into a functional relationship with the discriminated operant (e.g., Langthorne et al., 2007; Laraway et al., 2003; McGill, 1999). As mentioned in the introduction, a substantial body of published literature has demonstrated the positive effects of various antecedent interventions on challenging behavior with individuals with developmental disabilities (Luiselli, 2006). However, a truly scientific understanding (functional analysis) of why many of these antecedent interventions are effective has not occurred. Until we examine how interventions such as modifying a student’s routines/schedules impact the effects of discriminative stimuli and the value of reinforcers for challenging behavior we are relegated to pseudoscientific explanations (e.g., empowerment, self-determination) for why these strategies work. The antecedent communication intervention reduced, but did not eliminate, challenging behavior for Matthew and Mark. This seems to be a relatively common finding with other studies that have examined presession access to reinforcers for challenging behavior (e.g., Lang et al., 2010; O’Reilly et al., 2008). Given these findings, such antecedent interventions should not be seen as a panacea in the treatment of challenging behavior. Rather, antecedent interventions might be most effective when combined with consequence-based interventions (e.g., FCT) in treatment. Future research might examine functionally derived combinations of treatments (antecedent and consequence based treatments) versus consequence only treatments on challenging behavior. For example, it may be the case that consequence-based strategies might be easier to implement if challenging behavior is initially reduced using antecedent-based strategies. This is the first study to incorporate a functionally derived antecedent intervention (presession access to tangibles) within a typical curricular activity (communication training). While the results of this intervention are consistent both within and across the three participants, these methods should be replicated across additional participants. Future research should also
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examine the effectiveness of incorporating presession access interventions into other components of the school routine (e.g., play, self-care, etc.). We used the tangible condition of the functional analysis as a test condition to examine the effects of the antecedent communication intervention on tangibly maintained challenging behavior. The tangible test condition is a tightly controlled experimental preparation and may not be indicative of the complexities present in a regular classroom environment following the antecedent intervention. Future research should test the applied veracity of this antecedent communication intervention by examining the effects on challenging behavior within regular classroom activities. References Barlow, D. H., Nock, M. K., & Hersen, M. (2009). Single case experimental designs: Strategies for studying behavior change (3rd ed.). Boston: Allyn & Bacon. Berg, W. K., Peck, S., Wacker, D. P., Harding, J., McComas, J., Richman, D., et al. (2000). 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