© Borgis - Postępy Nauk Medycznych 1/2013, s. 65-70
*Linda S. Heitzman-Powell1, Kimberly K. Bessette2, Howard P. Wills2, Jill Marie Koertner1, Lisa Rusinko3
Usunięcie uwagi jako operacja motywująca podczas sesji „ucieczki” przeprowadzanych w ramach analizy funkcjonalnej
Assessing a Modified Functional Analysis Condition for Removal of Attention as an Establishing Operation in an Escape Functional Analysis Condition
1Center for Child Health and Development, University of Kansas Medical Center, USA
Head of Department: R. Matthew Reese, PhD
2 Juniper Gardens Children’s Project , University of Kansas, USA
Head of Department: Charles R. Greenwood, PhD
3Summit Behavioral Services, USA
Head of Department: Dan Matthews, MA
Częstość występowania u dzieci całościowych zaburzeń rozwoju, takich jak autyzm oraz zaburzeń emocji i zachowania ciągle wzrasta (1). Podopieczni dotknięci wyżej wymienionymi problemami zazwyczaj prezentują w środowisku szkolnym więcej zachowań trudnych niż ich typowo rozwijający się rówieśnicy. Prawodawstwo w USA (2) wymaga, aby u uczniów przejawiających niepoprawne zachowania, które utrudniają naukę im i innym dzieciom, dokonać funkcjonalnej oceny przyczyn ich powstania (ang. functional behavioral assessment – FBA). Odziaływania terapeutyczne powinny być oparte o wyniki oceny funkcjonalnej. Jedną z metod przeprowadzenia oceny funkcjonalnej jest analiza funkcjonalna, czyli eksperymentalna manipulacja czynnikami środowiskowymi w celu określenia ich wpływu na zachowanie trudne (3). U niektórych dzieci, analiza funkcjonalna nie przynosi jednak jasnych wyników. Obecne badanie dotyczy dwójki takich właśnie dzieci. Zostało ono przeprowadzone, aby ocenić zmodyfikowany warunek analizy funkcjonalnej (badający ucieczkę jako potencjalne wzmocnienie) pod kątem efektu utrzymywania stałej uwagi podczas sesji ucieczki. Badanie poszerza metodologię analizy funkcjonalnej w celu opracowywania interwencji dla dzieci, u których wyniki oceny funkcjonalnej nie wskazują jednoznacznie na funkcję zachowania trudnego. Omówiono walory i słabe strony przeprowadzonego badania, a także implikacje mediacyjnych efektów operacji ustanawiających na wynik analizy funkcjonalnej. Wyciągnięto wnioski, iż badania dotyczące procesu analizy funkcjonalnej powinny być dalej prowadzone.
The prevalence of students with developmental disabilities such as autism and those at risk for emotional and behavior disorders are steadily increasing (1). These students are more likely than their counter-parts to display challenging behaviors at school. Based on the Individuals with Disabilities Act (2), students that display behaviors that interfere with their learning and that of their classmates require a functional behavioral assessment (FBA) in order to develop an intervention plan based on function. In some instances, the FBA process includes a functional analysis (FA), or the systematic manipulation of environmental variables to determine the effect on behavior (3). For some children, this process does not produce a clear pattern of responding. This study is based on two such children and was developed to assess a modification of the escape condition in a traditional functional analysis (3) to determine the effects of holding attention constant in the escape condition. The present study expands on FA technology in order to be more effective at developing function-based intervention for children whose functional behavioral assessments suggest that their behavior is maintained by multiple functions. Strengths and limitations are discussed, along with implications of the mediating effects of establishing operations on the results of a functional analysis. The need for future research in the use of the FA process is discussed.
Autism spectrum disorders (ASDs) are present at birth or appear early in development and interfere with multiple areas of a person’s life (4). The Center for Disease Control’s (5) Autism and Developmental Disabilities Monitoring Network (ADDM) surveillance studies indicate autism suggests that autism affects 1 in 88 children across all racial, ethnic and socioeconomic groups. While there remains speculation around factors that may be contributing to this increase, children and adolescents with ASD frequently experience challenges in academic learning and often display behaviors that can restrict access to a general education placement.
When a child exhibits significant behavior challenges the development of a behavior intervention plan based on a functional behavioral assessment (FBA), is warranted. In some instances, an FBA may include a functional analysis (FA) to systematically test the hypothesized function of problem behaviors (3). The majority of these analyses include attention, escape, and automatic reinforcement conditions, as well as a comparison or control (6). Because these can sometimes result in undifferentiated outcomes researchers have begun to examine other variables that could potentially function as confounding variables in a traditional FA, such as demand characteristics (7), therapist attention (8), enriched environments (9, 10), assessment of changing function within conditions (11), and escape-to-attention (12, 13).
It is apparent that traditional FA conditions require modifications to address those individuals whose behavior is multiply controlled. This multiple control could perhaps present differently for individuals depending on many variables such as establishing operations (EO), states of deprivation or satiation for particular tangible or social stimuli, or whether the individual escapes to a reinforcing condition contributing to those analyses in which the results are ambiguous, or undifferentiated. For example, Roane, Lerman, Kelley, & Van Camp (14) addressed this ambiguity in a study in which they conducted a minute-by-minute analysis of within session changes in responding that they hypothesize was related to EO’s. An EO is an event that alters the effectiveness of reinforcing consequences as well as the likelihood the previously reinforced behaviors will occur (15). Roane, et al. hypothesized that the presence or absence of an EO could affect the occurrences of behavior within FA conditions. They state, „As a result, levels of responding should be higher in the absence of attention or tangible items than in the presence of these items” (pg. 76). Thus, in analyzing undifferentiated responding in traditional FA conditions, potential confounding variables should be controlled for within conditions in order to assess the true function of the behavior.
In the present analysis, we hypothesized that the removal of attention, which consistently co-occurs with the removal of demands during the escape condition, could potentially function as an EO for aberrant behaviors maintained by attention for children with undifferentiated traditional FA’s. If this were the case, then removing the task, but not attention would result in lower levels of problem behavior during the escape condition, assisting with the development of more targeted, function-based interventions.
Participants and Settings
Two school-age boys referred for problem behaviors in the classroom participated. Both students were enrolled in public schools in a Midwestern school district. Jon was served in a regular school setting; Erik was served in an alternative school which offered educational services to students in kindergarten through the 12th grade who engage in severe problem behaviors. Both boys had cognitive functioning and language in the normal range and were on grade-level for academic activities. Teacher and parent consents were obtained for participation in the FA conditions and treatment recommendations were incorporated into the individualized education plans (IEP). Jon was a six-year old Caucasian male with ASD in a general education first-grade classroom with a dedicated paraprofessional (para). Jon displayed elevated rates of inappropriate verbalizations (“I can’t do this”, “I’ll gut you with my light saber!”), physical aggression towards both adults and peers (hitting, kicking, stabbing with pencils), and had a history of behavior problems across settings and adults since preschool. Erik was a six-year-old kindergarten male diagnosed with attention deficit hyperactivity disorder, reactive attachment disorder, sensory integration dysfunction. Erik was nominated by his special education teacher, for verbal (making threatening comments such as “I am going to hurt you” or “I am going to kill you”) and physical (hitting and kicking) aggression, and other “disruptive” behaviors (throwing books, pencils, and papers).
Jon’s sessions were conducted in an unoccupied classroom next to the special education room where the child occasionally received pull-out services. The child was brought to the empty classroom from his general education classroom by his dedicated paraprofessional (para) for the FA procedures. Erik’s assessment was conducted in the Special Education classroom.
Materials included a functional analysis training package (16) to train the para. For Jon, worksheets requiring written responses on grade-level math problems were used during test conditions and toy dinosaurs with a plastic volcano during the play condition. For Erik, four color coded cards (one for each functional analysis condition) were added to be used by the para as visual cues for how to perform each condition. Other materials used during FA sessions for Erik were grade-level reading and writing worksheets during test conditions and a dominoes game during the play condition. Each condition was timed using a digital timer.
Functional Behavioral Assessment
For both students, a standard assessment protocol was conducted in which school personnel and parents were interviewed. The instrument and procedure followed the FBA model described by O’Neill, et al. (17). Based on the results of this assessment, it seemed that Jon engaged in various forms of problematic behaviors (e.g. non-compliance, verbal aggression, physical aggression towards peers, physical aggression towards adults, etc.) for a variety of “reasons” – that is, a discrete function was unclear. Based on the reported frequency and severity of occurrences, two of the elevated problem behaviors were targeted for the purposes of the FA: verbal (e.g. “I’ll hurt you”) and physical (hitting, kicking, stabbing) aggression. For Erik, the interview was conducted with the special education teacher with direct observations by the researcher during descriptive assessment sessions. Because the outcome of the interview was mixed and the problem behaviors placed him and others in danger (occurring 2-3 times per hour), the team decided to proceed with an FA.
Paraprofessional FA training
FA training consisted of three units which explained the procedures for escape, attention, and play conditions. This training package was based on procedures outlined by Iwata, et al. (3) and had demonstrated effectiveness at quickly teaching untrained adults how to implement each condition in a prior study (16). Paras were required to reach 100% level for answers to the study guide quizzes. Training took approximately 30 minutes, was conducted immediately prior to the session, and was accompanied by the instruction, “*If at any time, the child becomes hurt or is in danger of being hurt, end the session.” Subsequent to implementing the three traditional conditions with Jon, the training package was modified to include a modified escape condition. The second author provided the training and coaching to each para.
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