Children with intellectual disability often display severe destructive behaviors (e.g., aggression, self- injurious behavior) that pose significant risks to self or others and represent overwhelming barriers to community integration. These destructive behaviors are often treated with behavioral interventions derived from a functional analysis (FA), which is used to identify the environmental antecedents and consequences that occasion and reinforce the target response. One treatment that is inexorably linked to FA is called functional communication training (FCT), which involves extinction of destructive behavior and reinforcement of an alternative communication response with the consequence that previously reinforced destructive behavior. Results from epidemiological studies and meta analyses indicate that interventions based on an FA, like FCT, typically reduce problem behavior by 90% or more and are much more effective than other behavioral treatments. Despite these impressive findings, FCT interventions reported in the literature have typically been developed and evaluated by highly trained experts in tightly controlled research settings, and treatment effectiveness has not been established under more routine conditions. In addition, when attempts have been made to increase the practicality and ease of implementation of FCT for use by parents and other caregivers, treatment efficacy was markedly reduced in about 1/2 of cases and led to more intrusive procedures, such as punishment.1 The current project aims to address these limitations of FCT by (a) demonstrating the effectiveness of a simple and efficient empirical assessment for selecting the most appropriate FCT response;and (b) showing that by bringing the FCT response under the control of discriminative stimuli that are separate and distinct from those controlling destructive behavio using multiple schedules will (1) facilitate tranfer of treatment effects to routine caregivers and settings, (2) prevent resurgence of destructive behavior during periods when the FCT response does not produce reinforcement, and (3) prevent the need to add a punishment component to the FCT treatment package in order to sustain maximum treatment efficacy under routine conditions.

Public Health Relevance

Destructive behavior is a major health problem with critical physical, social, emotional, educational, and economic consequences. NICHD has identified an urgent need for studies on the development of therapeutic strategies for SIB and related disorders. The development of more effective, transportable, and practical behavioral interventions for severe destructive behavior has important public health implications.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Research Project (R01)
Project #
1R01HD079113-01A1
Application #
8722834
Study Section
Child Psychopathology and Developmental Disabilities Study Section (CPDD)
Program Officer
Urv, Tiina K
Project Start
2014-07-11
Project End
2019-06-30
Budget Start
2014-07-11
Budget End
2015-06-30
Support Year
1
Fiscal Year
2014
Total Cost
$434,549
Indirect Cost
$145,812
Name
University of Nebraska Medical Center
Department
Physical Medicine & Rehab
Type
Schools of Medicine
DUNS #
168559177
City
Omaha
State
NE
Country
United States
Zip Code
68198