Identifying Precursors to Severe Problem Behavior
Phase: NA
Conditions: Problem Behavior, Aggression
Sponsor: Hugo W. Moser Research Institute at Kennedy Krieger, Inc.

Assessing Potential Precursors to Severe Problem Behavior 
Study 1: Identification of Antecedent Behaviors 
 
Purpose: Study 1 will identify variables that maintain the participant’s severe problem behavior 
(SPB) and will identify antecedent behaviors (AB). 
   
Participants: Individuals, between the ages of 6 to 17 years old, who engage in severe problem 
behavior 
Safety Procedures: 
 
Safety Equipment: Click here to enter text. 
 
Restraints Worn: Click here to enter text. 
 
Permanently Blocked Behaviors Click here to enter text. 
 
Criteria for Session Termination: Click here to enter text. 
 
Data Collection:  Data will be collected on the rate of SPB and AB. Data will also be collected 
on percentage of compliance and duration of engagement and reinforcement. A lag sequential 
analysis using conditional probabilities will also be conducted. Conditional probabilities will be 
calculated using BDataPro Extended Analysis (binary method). A 10 s viewing window will be 
used to identify: 
1. The AB with highest conditional probability (AB  SPB) 
2. The AB with lowest background probability (AB  SPB) 
3. The AB with lowest conditional probability  
Stability Criteria: Mean +/- .25SD 
Data will be considered stable if three consecutive data points fall within +/- .25 standard 
deviation of the mean. This criterion will be used in conjunction with visual inspection. 
Researchers will use visual inspection to determine the following: 
 
No decreasing trend 
 
Lack of responding 
 
Materials: Materials will include: 
 
Table 
 
Two chairs 
 
Demand materials 
 
Highly preferred items 
 
Protective equipment (if applicable) 
 
Study 1: 

The functional analysis (FA) will be conducted by the clinical team. In the event that the clinical 
team is unable to conduct the FA, the research team will conduct an FA / Pairwise. 
General:  
1. Sessions will be 10 minutes in length and conducted in a padded treatment room 
2. The sequence of conditions within each series will occur as follows (see Appendix A):  
o Alone (or Ignore) 
o Attention 
o Tangible (if included) 
o Toy Play 
o Demand 
3. Once the FA is complete, the research team will review FA sessions via video 
playback and score all behaviors emitted by the participants 
Precursor Selection: 
1. Greatest difference between conditional and background probability 
2. Occurs frequently 
3. Can be blocked ethically (e.g., Vocal statements cannot be ethically blocked) 
4. Easily operationally defined without many variations 
5. Individuals who engage in precursors that are topographically similar proto-
problem behavior are not recommended for participation in the Study 2 or 3. 
 
KEY ASSIGNMENTS 
1 
Target Behavior 
(SIB, if applicable) 
Operationally define 
2 
Target Behavior 
(AGG, if applicable) 
Operationally define 
3 
Target Behavior 
 (DIS, if applicable) 
Operationally define 
4 
Antecedent Behavior Operationally define 
5 
Antecedent Behavior Operationally define 
6 
Antecedent Behavior Operationally define 

7 
Attention 
 
Therapist delivers brief attention contingent upon target PB 
8 
Initial Prompt 
 
Therapist delivers verbal prompt 
9 
Compliance 
Compliance following the verbal or gestural prompt 
E 
Engagement  
3 sec onset/offset – (for toy play and tangible conditions) includes any 
attempt to manipulate the toy that is not destructive or harmful to self or 
others. Includes stereotypy with the item, does not include mere contact  
R 
Reinforcement  
 
Immediate onset/offset – (for demand and tangible conditions) 30s escape 
or access to tangible item  
 
 
 
 
 

Appendix A 
 
GENERAL PROCEDURE 
1. If a complete series cannot be completed before the end of the session block try to 
avoid stopping after the alone condition (it’s ideal for the alone condition to 
immediately proceed the attention condition), but if there is only enough time to run the 
alone condition, then do so  
2. An upcoming session may be briefly delayed if the patient continues to display a burst of 
problem behavior after the end of the previous session, but no longer than 5-minutes 
should separate each session with the exception of the termination of sessions at the 
end of the session block and the end of the day. The SBA/PI should determine a 
description of agitated/calm behavior and the duration the patient must be calm to 
continue sessions (the next session should begin as soon as calm criteria has been 
met). If this occurs multiple times, discuss again with your SBA 
3. Ignore problem behavior between sessions and provide minimal attention in general 
unless otherwise specified by the SBA 
4. Though the decision to terminate the FA is ultimately up to the SBA/PI, in general, the 
FA is complete when either: 
o Differential responding is observed over the course of at least three series 
o 10 complete series are conducted 
o In cases in which the FA is undifferentiated because the patient does not exhibit 
the target behavior, stop after six series 
CONDITIONS 
Alone  
Discuss with the SBA whether an alone condition should be included. If so, an alone condition is 
preferable to an ignore condition, and should be conducted unless the patient cannot be left 
alone in the room (e.g., SIB requires blocking, the patient is afraid to be left alone in the room); if 
this is the case, conduct an ignore condition instead of alone.  
 
Materials: 1 chair, unless a target behavior requires materials (e.g., baited room for pica 
or disruption) 
 
Instructions to patient: “You need to stay in here for a little while. I’ll be back in about 
10 minutes.” (Discuss with the SBA whether or not instructions will be given) 
 
Stimulus condition: The patient is alone in the room with no toys available 
 
Note: Inform SBA if the patient repeatedly asks or attempts to get out of the room, or 
engages in problem behavior that appears to be related to being in the room 
 
Modifications: Click here to enter text. 
*** (delete whichever condition is not applicable for your patient, Alone or Ignore) *** 
Ignore  
Only conduct the ignore condition with patients who cannot be left alone in the room for the 
alone condition. Discuss with your SBA if aggression is the only target problem behavior. 

 
Materials: 2 chairs, unless a target behavior requires materials (e.g., baited room for 
pica or disruption) 
 
Instructions to patient: “You need to stay in here for a little while. I will not be 
available.”  
 
Stimulus condition: The patient is in the room with no toys available. The therapist is 
also present, standing or seated approximately 8ft away from the patient. The therapist 
does not look at or engage with the patient in any way  
 
Consequence for target behavior: Ignore all behaviors. Block only when necessary to 
maintain safety or for other behaviors specified by the SBA (e.g., restraint removal). If 
blocking occurs in the ignore condition, it must occur throughout all ignore sessions in 
the analysis 
 
Note: Inform SBA if the patient repeatedly asks or attempts to get out of the room, or 
engages in problem behavior that appears to be related to being in the room 
 
Modifications: Click here to enter text. 
Attention 
Conduct the attention condition with all patients. 
 
Materials: 2 chairs, low preferred toys (generally, lowest three items from the preference 
assessment, but review with SBA), item for therapist to focus on (e.g., magazine)  
 
Instructions to patient: “I need to do some work and will not be available for the next 
10-minutes.” 
 
Stimulus condition: The therapist sits in the chair and pretends to be busy, low 
preferred toys are available for the patient to play with independently   
 
Consequence for target behavior: Provide brief social attention and non-punitive 
physical contact (e.g., “Don’t do that, you’ll hurt yourself” while placing a hand on the 
patient’s shoulder; or “You’re going to break that” while touching patient’s arm) for each 
occurrence of target behavior. If problem behavior is occurring very rapidly (e.g., multiple 
responses per second), provide continuous attention, but you do not need to provide a 
separate statement for each occurrence  
 
Consequence for other behavior: Ignore 
 
Note: Notify SBA if the patient attempts to obtain attention appropriately (e.g., lightly 
taps therapist, verbally requests attention, etc.) 
 
Modifications: Click here to enter text. 
Tangible 
Only conduct the tangible condition if maintenance of problem behavior by positive 
reinforcement in the form of access to preferred items is suspected based on observation or 
staff report. 
 
Materials: 2 chairs, highly preferred toy(s) (with history of problem behavior associated 
with removal): Click here to enter text. 
 
Instructions to patient: “You may play with your toy for a few minutes and then it will be 
put away.” 
 
Stimulus condition: Allow the patient 2-minutes access to the toy prior to beginning the 
session (therapist and patient are together in room, but no data are collected). At the 

end of the 2-minute period and immediately prior to the start of session, tell the patient, 
“Time to put this away.” If the patient does not hand over the item, take the item from the 
patient without further prompting. Once session begins, sit or stand in the room holding 
the toy  
 
Consequence for target behavior: Say “okay” and return the toy to the patient for 30s. 
Provide no social attention, and do not play with the patient. Ignore subsequent 
behaviors, but continue to score. Take the toy back after 30s 
 
Consequence for other behavior: Ignore 
 
Note: If the patient does not engage with the toy during the 2-minutes pre-session 
access, stop and notify your SBA. Ignore appropriate requests for the toy, but notify the 
SBA if this occurs 
 
Modifications: Click here to enter text. 
Toy Play 
Conduct the toy play condition with all patients. 
 
Materials: 2 chairs, highly preferred toys (generally, top three items from the preference 
assessment, but review with SBA): Click here to enter text. 
 
Instructions to patient: “We’re going to play with some toys for a while.” 
 
Stimulus condition: Preferred toys are available. The therapist sits in a chair and a 
chair is available for the patient. The therapist will not prompt the patient to play with the 
toys and will not make any requests of the patient/place any demands  
 
Consequence for target behavior: Ignore 
 
Consequence for other behavior: Ignore 
 
Delivery of attention: If the patient initiates play or communication, interact with the 
patient or engage in parallel play. If the patient does not initiate interaction, provide non-
contingent attention every 30-seconds (e.g., 5-10s of attention/praise, “I like the way 
you’re playing”). If the patient is engaging in problem behavior, implement a 5s delay 
before delivering attention 
 
Note: Notify SBA if the patient engages in avoidance behavior, responds negatively to 
attention 
 
Modifications: Click here to enter text. 
Demand 
Conduct the demand condition with all patients. 
 
Materials: table, 2 chairs, demand materials: Click here to enter text. 
 
Demands: Identify five tasks through caregiver interview and/or informal observation 
that appear to be nonpreferred. These tasks may vary in response effort and in skill 
domain, as needed. Present each task an equal number of times in a quasi-random 
order (i.e., present all five tasks once before repeating any) 
1. Click here to enter text. 
2. Click here to enter text. 
3. Click here to enter text. 
4. Click here to enter text. 
5. Click here to enter text. 

 
Instructions to patient: “We are going to do some work for a while.” 
 
Stimulus condition: The patient and therapist are seated at the table. During each 
session, the therapist will continuously present instructional trials using three-step 
guided compliance at a 5s inter-prompt interval  
 
Consequence for target behavior:  
o During the demand sequence/demands present: Immediately remove the 
demand materials (do not provide attention), turn away, and do not look directly 
at the patient. Provide escape even if problem behavior occurs before the prompt is 
issued (e.g., as you place the demand materials back on the table, the patient engages in 
a target problem behavior, then provide escape as previously described)—be sure to 
discuss with your SBA. Issue a new demand after 30s 
o During the 30s escape period: Ignore and do not look at the patient. Continue to 
score target behaviors during the escape period. Issue a new demand after 30s 
 
Consequence for other behavior: Ignore 
 
Consequence for compliance: Provide verbal praise for compliance following the 
verbal or gestural prompt 
 
Note: Discuss with your SBA whether demands will continue to be presented even if the 
patient leaves the table or whether they will be physically guided back to the table. Notify 
your SBA if the patient appropriate request a break 
 
Modifications: Click here to enter text. 
 
 

Assessing Potential Precursors to Severe Problem Behavior 
Study 2: Experimental Precursor Analysis 
 
Purpose: Study 2 will be conducted following the identification of a likely precursor and the 
maintaining variable of the likely precursor during Study 1. Study 2 will identify the functional 
relation between the likely precursor and severe problem behavior. 
 
Participants: Individuals who have completed Study 1 and a likely precursor was identified 
 
Safety Procedures: 
 
Safety Equipment: Click here to enter text. 
 
Restraints Worn: Click here to enter text. 
 
Permanently Blocked Behaviors Click here to enter text. 
 
Criteria for Session Termination: Click here to enter text. 
 
Data Collection:  Data will be collected on the rate of SPB and likely precursor. Data will also 
be collected on the duration of reinforcement.  
Stability Criteria: Mean +/- .25SD 
Data will be considered stable if three consecutive data points fall within +/- .25 standard 
deviation of the mean. This criterion will be used in conjunction with visual inspection. 
Researchers will use visual inspection to determine the following: 
 
No decreasing trend 
 
Lack of responding 
 
Materials: Materials will include: 
 
Table 
 
Two chairs 
 
Demand materials (if applicable) 
 
Highly preferred items (if applicable) 
 
Protective equipment (if applicable) 
 
Study 2: 
General:  
4. Sessions will be 5 minutes in length and conducted in a padded treatment room 
5. Sessions will be identical to the FA condition in which function was found during Study 1 
(Attach session description to Study 2 – Appendix A) 
o FA condition where function was found: Click here to enter text. 

6. A reversal or multielement design will be used to demonstrate the functional relation 
between the likely precursor and SPB. 
 
One these conditions is identical to the relevant FA condition (named CR SPB / EXT 
Precursor below) 
o Thus, the design should accommodate the extant data from Study 1 (e.g., in a 
reversal, the initial A phase should come from Study 1). 
7. This analysis includes the following sequence of conditions:  
o Contingent Reinforcement for precursor and extinction for severe problem 
behavior (CR Likely Precursor / EXT SPB) 
o Contingent Reinforcement for severe problem behavior and extinction for the 
likely precursor (CR SPB / EXT Likely Precursor) 
o Noncontingent Reinforcement (NCR) 
8. Problem behavior: Click here to enter text. 
9. Likely precursors: Click here to enter text. 
10. If the likely precursor cannot be ethically blocked, the participant should not be 
included in Study 3 
 
CONDITIONS 
CR Likely Precursor / EXT SPB 
 
The experimenter will deliver the functional reinforcer to the participant contingent on the 
occurrence of a likely precursor. 
 
All SPB will be ignored. 
CR SPB / EXT Likely Precursor 
 
The experimenter will deliver the functional reinforcer to the participant contingent on the 
occurrence of SPB. 
 
All likely precursors will be ignored. 
NCR 
 
The functional reinforcer will be provided independent of responding. 
 
The reinforcement schedule will be yoked to rate of delivery of reinforcement during the 
immediately preceding condition. (e.g., reinforcement will be delivered every 30 s if 
reinforcement was delivered contingent on SPB/precursor every 30 s during the session 
immediately preceding the initial NCR session).   
 
The amount of reinforcement will be equal to the reinforcement delivered in the 
immediately preceding condition (e.g., 10 s of attention will be delivered if attention was 
delivered for 10 s contingent on SPB/precursor during the session immediately 
preceding the initial NCR session).  
 
All SPB and likely precursors will be ignored. 
 
 

 
 
 
 
Target Behavior 
 
Problem Behavior 
Likely Precursor 
Condition 
CR Likely 
Precursor / EXT 
SPB 
Ignore 
Reinforcement 
CR SPB / EXT 
Likely Precursor 
Reinforcement 
Ignore 
NCR 
Ignore 
Ignore 
 
 
 

KEY ASSIGNMENTS 
1 
Target Behavior 
(SIB, if applicable) 
Operationally define 
2 
Target Behavior 
(AGG, if applicable) 
Operationally define 
3 
Target Behavior 
 (DIS, if applicable) 
Operationally define 
4 
Likely Precursor  
Operationally define 
7 
Attention 
 
Therapist delivers brief attention contingent upon target PB 
8 
Initial Prompt 
 
Therapist delivers verbal prompt 
9 
Compliance 
Compliance following the verbal or gestural prompt 
E 
Engagement  
3 sec onset/offset – (for toy play and tangible conditions) includes any 
attempt to manipulate the toy that is not destructive or harmful to self or 
others. Includes stereotypy with the item, does not include mere contact  
R 
Reinforcement  
 
Immediate onset/offset – (for demand and tangible conditions) 30s escape 
or access to tangible item  
 
 
 
 
 

Assessing Potential Precursors to Severe Problem Behavior 
Study 3: Identification of Precursor-SPB Relation 
 
Purpose: Study 3 will examine the type of precursor-SPB relation; 1) response class or 2) 
behavioral chain 
   
Participants: Individuals who have completed Study 2 and a likely precursor was identified and 
can be ethically blocked 
Safety Procedures: 
 
Safety Equipment: Click here to enter text. 
 
Restraints Worn: Click here to enter text. 
 
Permanently Blocked Behaviors Click here to enter text. 
 
Criteria for Session Termination: Click here to enter text. 
 
Data Collection:  Data will be collected on the rate of SPB and likely precursor. Data will also 
be collected on the duration of reinforcement.  
Stability Criteria: Mean +/- .25SD 
Data will be considered stable if three consecutive data points fall within +/- .25 standard 
deviation of the mean. This criterion will be used in conjunction with visual inspection. 
Researchers will use visual inspection to determine the following: 
 
No decreasing trend 
 
Lack of responding 
 
Materials: Materials will include: 
 
Table 
 
Two chairs 
 
Demand materials (if applicable) 
 
Highly preferred items (if applicable) 
 
Protective equipment (if applicable) 
 
Study 3: 
General:  
11. If the likely precursor identified in Study 2 cannot be ethically blocked, the 
participant should not be included in Study 3. 
12. Sessions will be at least 5 minutes in length and conducted in a padded treatment 
room 

13. Sessions will be identical to the FA condition in which function was found during Study 1 
(Attach session description to Study 3 – Appendix A) 
o FA condition where function was found: Click here to enter text. 
14. A reversal or multielement design will be used to compare the two conditions. 
15. This analysis includes the following sequence of conditions:  
o Blocking 
o No Blocking 
16. Problem behavior: Click here to enter text. 
17. Likely precursors: Click here to enter text. 
CONDITIONS 
Precursor Blocking 
 
The experimenter will block the participant from any attempt to engage in the precursor. 
 
The experimenter will deliver the functional reinforcer contingent on every occurrence of 
SPB 
 
Engaging in precursors will not result in reinforcement delivery. That is, if a participant 
successfully engages in a precursor, the precursor will be ignored. 
No Precursor Blocking 
 
The experimenter will deliver the functional reinforcer contingent on every occurrence of 
SPB. 
 
All precursors will be ignored. 
 
 
 
 
 
 
Target Behavior 
 
Problem Behavior 
Likely Precursor 
Condition 
Blocking 
Reinforcement 
Block 
No Blocking 
Reinforcement 
Ignore 
 
 
 

KEY ASSIGNMENTS 
1 
Target Behavior 
(SIB, if applicable) 
Operationally define 
2 
Target Behavior 
(AGG, if applicable) 
Operationally define 
3 
Target Behavior 
 (DIS, if applicable) 
Operationally define 
4 
Antecedent Behavior Operationally define 
5 
Antecedent Behavior Operationally define 
6 
Antecedent Behavior Operationally define 
7 
Attention 
 
Therapist delivers brief attention contingent upon target PB 
8 
Initial Prompt 
 
Therapist delivers verbal prompt 
9 
Compliance 
Compliance following the verbal or gestural prompt 
E 
Engagement  
3 sec onset/offset – (for toy play and tangible conditions) includes any 
attempt to manipulate the toy that is not destructive or harmful to self or 
others. Includes stereotypy with the item, does not include mere contact  
R 
Reinforcement  
 
Immediate onset/offset – (for demand and tangible conditions) 30s escape 
or access to tangible item  
 
 
 
 
 
 

Statistical Analysis Plan 
Study 3 was the clinical trial. No individuals participated in Study 3, thus the statistical analysis 
plan was not implemented.