Children with intellectual disability often display severe destructive behaviors (e.g., aggression, self-injurious behavior) that pose significant risk 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 such treatment 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 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 relapse (i.e., increased destructive behavior) often occurs in the natural environment when a caregiver is unable reinforce the FCT response due to competing responsibilities (e.g., caring for a sick sibling). Behavioral momentum theory helps to explain why treatment relapse occurs under these circumstances and also provides mathematical equations that can be used to model and predict the variables that increase and decrease the likelihood that treatment relapse will occur. In the current project, we have used these equations to identify several potential refinements to FCT that are likely to markedly decrease the probability that treatment relapse will occur when the FCT response is not reinforced. In some cases, these refinements are at odds with what is recommended in the clinical literature on FCT. Therefore, it is critically important that we compare these refinements that are derived from behavioral momentum theory with current clinical practice in order to determine the best way to implement FCT, so that treatment remains effective when it is implemented with less than perfect precision by caregivers in the natural environment.

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 self-injurious behavior and related disorders. The refinement of behavioral interventions for severe destructive behavior that remain effective when implemented in natural environments 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 #
5R01HD083214-02
Application #
9128656
Study Section
Child Psychopathology and Developmental Disabilities Study Section (CPDD)
Program Officer
King, Tracy
Project Start
2015-08-18
Project End
2020-04-30
Budget Start
2016-05-01
Budget End
2017-04-30
Support Year
2
Fiscal Year
2016
Total Cost
Indirect Cost
Name
University of Nebraska Medical Center
Department
Type
Overall Medical
DUNS #
168559177
City
Omaha
State
NE
Country
United States
Zip Code
68198
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Fisher, Wayne W; Greer, Brian D; Mitteer, Daniel R et al. (2018) Further evaluation of differential exposure to establishing operations during functional communication training. J Appl Behav Anal 51:360-373
Briggs, Adam M; Akers, Jessica S; Greer, Brian D et al. (2018) Systematic Changes in Preference for Schedule-Thinning Arrangements as a Function of Relative Reinforcement Density. Behav Modif 42:472-497
Mitteer, Daniel R; Greer, Brian D; Fisher, Wayne W et al. (2018) A laboratory model for evaluating relapse of undesirable caregiver behavior. J Exp Anal Behav 110:252-266
Phillips, Lauren A; Briggs, Adam M; Fisher, Wayne W et al. (2018) Assessing and Treating Elopement in a School Setting. Teach Except Child 50:333-342
Lichtblau, Katherine R; Romani, Patrick W; Greer, Brian D et al. (2018) Remote treatment of sleep-related trichotillomania and trichophagia. J Appl Behav Anal 51:255-262
Fisher, Wayne W; Greer, Brian D; Fuhrman, Ashley M et al. (2018) Minimizing resurgence of destructive behavior using behavioral momentum theory. J Appl Behav Anal 51:831-853
Saini, Valdeep; Fisher, Wayne W; Retzlaff, Billie J (2018) Predictive validity and efficiency of ongoing visual-inspection criteria for interpreting functional analyses. J Appl Behav Anal 51:303-320
Mitteer, Daniel R; Greer, Brian D; Fisher, Wayne W et al. (2018) Teaching behavior technicians to create publication-quality, single-case design graphs in graphpad prism 7. J Appl Behav Anal 51:998-1010
Fisher, Wayne W; Saini, Valdeep; Greer, Brian D et al. (2018) Baseline reinforcement rate and resurgence of destructive behavior. J Exp Anal Behav :

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