Behavioral Economics and Communication
Condition: Problem Behavior
MeSH terms: Problem Behavior
Study type: Interventional

Summary: 
      This project examines mechanisms to address two significant challenges present in
      communication-based behavioral interventions for individuals with autism and comorbid severe
      destructive behavior (SDB): (a) inflexible communication responding and (b) reemergence of
      severe destructive behavior when challenges to treatment integrity occur. Achieving the
      proposed aims will advance clinical practice related to the treatment of SDB and
      generalization of treatment effects to mitigate against the resurgence of SDB
    

Detailed description: 
      Approximately 25% of individuals with autism spectrum disorder (ASD) are affected by
      co-morbid severe destructive behavior (SDB). Although there is an extensive body of
      literature supporting the use of behavioral interventions for decreasing the occurrence of
      SDB, challenges in the clinical application of these interventions still exist. The current
      research proposes to evaluate mechanisms for mitigating two potentially significant treatment
      challenges: (a) invariant responding and (b) resurgence of problem behavior. Functional
      Communication Training (FCT) is a common reinforcement-based treatment for SBD that involves
      reinforcement of a target communication response to replace SDB such that communication
      produces the desired behavior outcome and SDB does not. However, in typical practice only a
      single communication response is taught thus limiting an individual's ability to communicate
      if that response is not observed (e.g., touching a card) or if the device used for
      communication fails (e.g., iPad battery dies). Furthermore, a core deficit of ASD is
      engagement in restrictive patterns of behavior; thus, individuals with ASD might show a
      preference for only emitting one communication response among concurrently available
      alternatives. As noted above, if the preferred communication modality is unavailable, an
      individual may revert back to engaging in SDB rather than using another, more appropriate
      communication response - a condition generally referred to as treatment relapse. Evidence for
      such outcomes can be found in studies in which a FCT response is placed on extinction (i.e.,
      the response no longer produces reinforcement) and SDB immediately increases. One potential
      way to mitigate against such issues is to teach multiple FCT responses. That is, teaching
      multiple communication responses may inoculate the individual against invariant communication
      responding thus reducing SDB.

      Related to this, a preferred clinical practice in treating SDB with FCT is to teach the
      individual to tolerate delays to reinforcement following communication (e.g., waiting until
      the caregiver is available to interact with the child). When communication is not immediately
      reinforced, there exists an additional possibility of treatment relapse. Resurgence is one
      type of treatment relapse in which a previously reduced response re-emerges as a result of a
      procedural change. For example, relapse of SDB is a clinical concern often observed when
      delays to reinforcement are introduced. That is, when immediate reinforcement is no longer
      provided contingent on the target communication response, the individual might revert to
      engaging in SDB. Given that only one communication response is typically taught during FCT,
      the effects of teaching multiple communication responses on the mitigation of resurgence
      remains unknown.

      Mitigating invariant responding and resurgence has the potential to greatly impact the lives
      of individuals with ASD affected by SDB by helping to ensure that positive treatment outcomes
      maintain across time even in the presence of challenges to treatment such as procedural
      integrity errors and delays to obtaining reinforcement for appropriate behavior. Thus, the
      proposed research seeks to strengthen the current literature base and advance current
      clinical practice through completion of the following aims:

      Aim 1. Identify multiple functionally equivalent communication responses and assess levels of
      variant responding under rich schedule requirements.

      Aim 2. Evaluate the effects of a behavioral economic analysis on changes in variant
      communication responding across multiple communication responses across progressively leaner
      schedule requirements.

      Aim 3. This aim is exploratory in nature as we will assess the extent to which we observe
      resurgence of SDB following the introduction of multiple communication responses and
      manipulation of reinforcement schedules for the various responses.
    

Intervention name(s): functional communication training
Intervention type(s): Behavioral
Intervention description(s): During functional communication training, signaled intervals of reinforcement (i.e., the functional reinforcer is available contingent on communication) and extinction (i.e., the functional reinforcer is unavailable and thus both problem behavior and communication are on extinction) will be alternated within a single session. All communication responses will be reinforced every time they occur during the signaled reinforcement intervals.
Other intervention name(s): differential reinforcement
Intervention model: Single Group Assignment
Intervention model description: Single-case research design including multielement and reversal strategies
Masking: None (Open Label)
Primary purpose: Treatment