Acknowledging essentials, inferences, and all that you are willing to not know when functionally analyzing behavior

Transcription

1 Acknowledging essentials, inferences, and all that you are willing to not know when functionally analyzing behavior Gregory P. Hanley. Ph.D., BCBA-D BABAT October, 216 For more information and free materials, go to:

2 Be wary of incontrovertible truths.

3 All models are wrong; some are useful. Box & Draper, 1987, p. 424

4 Functional assessment process to determine the variables influencing problem behavior

5 Some Assumptions Problem behavior is an operant Certain situations potentiate certain consequences

6 Goal of a Functional Assessment Identify the consequences that maintain problem behavior Identify the situations that evoke the behavior In order to treat problem behavior

7 Functional Assessment Process Indirect Assessment Interview Descriptive Assessment Observe Functional Analysis Observe while manipulating

8 Defining features of the Standard Functional Analysis Multiple test conditions Uniform test conditions Isolated test contingencies Reinforce dangerous behavior only Toy-play control condition

9 Problem Behavior Per Minute Example of a standard functional analysis Sessions

10 How do we know this is the standard functional analysis? (Jessel, Hanley, Ghaemmaghami, 216) Multiple test conditions Uniform test conditions Isolated test contingencies Reinforce dangerous behavior only Toy-play control condition (Hanley et al., 23) 64% SFAs 1 out 3 with modifications (Beavers et al., 214) 85% SFAs 1 out of 7 with modifications

11 Is the Standard Functional Analysis Effective? Does it lead to a differentiated analysis? Literature reviews: Hanley et al. (23): approx. 94% Beavers et al. (214): approx. 92% Case series: Hagopian et al. (214): 47% Slaton et al. (216): 44%

12 Is the Standard Functional Analysis Effective? Does it leads to larger treatment effect sizes? Campbell (23) Higher PZD when Rx was based on EFA But, these larger effects were almost exclusively obtained when researchers implemented the treatments in controlled settings under rich schedules of reinforcement

13 Is the Standard Functional Analysis Effective? Not one study showing practical outcome in relevant context (e.g., school, home, community) with only a function-based treatment when a standard functional analysis was used

14 Is the Standard Functional Analysis Effective? Not one study showing the social acceptability of the process when a standard functional analysis was used

15 Is the Standard Functional Analysis Effective? Not one study showing a socially-validated effect on problem behavior when a standard functional analysis was used

16 Apparent solution to ineffectiveness: Excessive elaboration

17 Prior to a SFA Elaboration of the standard functional analysis (SFA) Formal Descriptive assessments Preference assessments Demand Assessments Manuals outlining extensive team-based processes Following a failed SFA Slight and systematic deviations from the SFA core procedures Following a failed SFA-based treatment Stimulus avoidance assessments More preference assessment and reinforcer assessments

18 Despite the Excessive Elaboration of the Standard Functional Analysis Not one study showing a practical outcome in a relevant context the social acceptability of the process a socially-validated effect on problem behavior

19 Since all models are wrong, the scientist cannot obtain a correct one by excessive elaboration. Just as the ability to devise simple but evocative models is the signature of the great scientist so overelaboration is often the mark of mediocrity. George Box, 1976, p. 792

20 Research to practice gap Possible reason: Because the outcomes are mediocre even when the process is elaborate

21 Functional analysis has been around for approx. 5 years (e.g., Lovaas et al., 1965; Sailor et al., 1968) Standard functional analyses have been around 34 years (Iwata et al., 1982) Over 3 studies containing over 5 standard functional analyses have been published (Jessel et al., 216) Yet, 55 to 65% of practitioners recently surveyed reported never conducting a functional analysis (Oliver et al., 216; Roscoe et al., 215)

22 IISCA Interview-informed Synthesized Contingency Analysis

23 Standard Functional Analysis Multiple test conditions Uniform test conditions Isolated test contingencies Reinforce dangerous behavior Toy-play control condition Interview-Informed Synthesized Contingency Analysis Single-test condition Individualized test conditions Synthesized contingencies Reinforce precursors to and dangerous behavior Test-matched control

24 An IISCA 4 Problem Behavior per min Escape/ Tangible/ Attention Zeke Sessions

25 Some Important Aspects of the IISCA 1. An open-ended interview is always part of the process Primary goals are to identify: a) co-occurring topographies of problem behavior b) events/interactions that appear to routinely evoke problem behavior c) interactions that follow problem behavior and are reported to stop it Interviews allow for discoveries which can then be verified (or not) in the IISCA

26 Some Important Aspects of our Approach 2. We synthesize multiple contingencies into one test condition which contingencies and the specific materials and interactions are informed by the interview

27 Why might problem behavior occur? Single contingencies: 1. Attention or toys (social-positive reinforcement) 2. Escape/avoidance (social-negative reinforcement) 3. Sensory/non-social (automatic reinforcement) Combinatorial contingencies: 1. Attention and Toys 2. Escape to toys 3. Escape to toys and attention 4. Escape to automatic reinforcement 5. Compliance with mands 6. Escape to access to rituals, preferred conversations 7. Etc..

28 Case Example (Bob, 8 yo, dx: Autism) Therapist: Sandy Jin Setting: Clinic Inextricable synthesis Escape / Tangible Hypothesis: Bob engages in meltdowns and aggression in order to obtain: His way in the form of escape from adult instructions and access to preferred ways of interacting with electronics or academic materials Problem Behavior per Min Escape / Tangible Bob (Ipad context) Bob (Math context) Sessions

29 Elective synthesis (with initial verification) Hypotheses: Case Example (Gail, 3 yo, dx: PDD-NOS) Therapist: Nicholas Vanselow Setting: Clinic Gail engages in meltdowns and aggression in order to obtain: preferred (tangible) items and maternal attention Problem Behavior per Min Analyst Tangible / Attention Tangible Attention Mother Analyst Analyst Mother Sessions Test Control Meltdowns Col 46 Gail

30 Why synthesize? 1. Seems to emulate the ecology better

31 Why synthesize? 1. Seems to emulate the ecology better 2. Isolated contingencies sometimes do not control behavior whereas synthesized contingencies do. Call et al., 25 Dolezal & Kurtz, 21 Hanley et al., 214 Ghaemmaghami et al., 216 Mueller et al., 25 Slaton et al., 216 Slaton et al., 216

32 Type of contingency IISCA Decoupled IISCA Synthesized Isolated Synthesized Food, attention Test Control Addison Attention Tangible (food) Control Problem behavior per min Escape to tangibles, attention Escape to compliance with requests Jay Franklin Attention Tangible Escape Control Escape Requests Control Slaton et al., 216

33 Why synthesize? 1. Seems to emulate the ecology better 2. Isolated contingencies sometimes do not control behavior whereas synthesized contingencies do. 3. Doing so leads to effective action meaningful treatment effects Hanley et al., 214, Santiago et al., 216; Ghaemmaghami et al., 216

34 Some reasonable questions: Have IISCAs been replicated? (I.e., Do they have generality?) Yes.

35 12 Will Wayne Sam Allen Kat (Cxt 1) 8 4 Test Control 6 Jack (Cxt 1) Keo Jeff Zeke Kat (Cxt 2) 4 2 From Jessel, Hanley, and Ghaemmaghami (JABA, 216) Problem behavior per min 6 Alex (Cxt 2) Chris Mike Mitch Gary Jian Earl Alex (Cxt 1) Beck Roxy 2. Paul Dan Kristy Jim Sid Lee Steve Jesse Jack (Cxt 2) Carson Sessions

36 Problem behavior per minute From Rajaraman et al. (216) Sessions

37 Has the process been socially validated? Yes. Social Acceptability Questionnaire Results Ratings Questions Gail Dale Bob Mean 1. Acceptability of assessment procedures Acceptability of treatment packages Satisfaction with improvement in problem behavior Helpfulness of consultation Note. 7=highly acceptable, highly satisfied, or very helpful 1=not acceptable, not satisfied, or not helpful from Hanley et al., JABA, 214

38 Has the process been socially validated? Yes. from Santiago et al., JADD, 216

39 Have socially validated treatments been developed from the IISCA? Have socially validated effects been achieved from the IISCA?

40 Socially validated treatments and outcomes. Yes. Social Acceptability Questionnaire Results Ratings Questions Gail Dale Bob Mean 1. Acceptability of assessment procedures Acceptability of treatment packages Satisfaction with improvement in problem behavior Helpfulness of consultation Note. 7=highly acceptable, highly satisfied, or very helpful 1=not acceptable, not satisfied, or not helpful from Hanley et al., JABA, 214

41 Socially validated treatments and outcomes. Yes. from Santiago et al., JADD, 216

42 Reinforcement (%) Problem Behavior per min Simple FCR per min Complex FCR per min Tolerance Response per min BL FCT + EXT Denial and Delay Tolerance Training Simple FCR Complex FCR 1 Response Chaining Treatment Extension Zeke Treatment: Unpredictable and intermittent reinforcement of communication, toleration, and compliance Implemented by relevant caregivers in relevant contexts who impose relevant and historically challenging routines 1 Response to Instructions (%) Noncomp. Compliance Levels Sessions from Santiago et al., JADD, 216

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44 Let s compare. Standard Functional Analysis IISCA Number of differentiated analyses 5+ x 34 Social validation of assessment process x Social validation of derived Rx x Social validation of outcome x

45 Towards a more efficient analysis Functional analysis format Standard Other Trial-based Brief Latency-based IISCA Single-test IISCA Min Max Analysis duration (min) N = 456 N = 115 N = 21 N = 64 N = 6 N = 34 N = 8 Jessel et al., 216

46 Let s compare. Standard Functional Analysis IISCA Number of differentiated analyses 5+ x 34 Social validation of assessment process x Social validation of derived Rx x Social validation of outcome x Efficiency x (average: 245 min) (average: 25 min)

47 Levels of Analytic Control Strong Test condition: Control condition: Consistently elevated rates Zero or near-zero rates Problem Behavior per Min Test Control Sessions Moderate Test condition: Control condition: Some zeros or near-zero rates Zero or near-zero rates Problem Behavior per Min Test Control Weak Test Condition: Control condition: Variable but higher rates Lower but non-zero rates Problem Behavior per Min Sessions Test Control Sessions

48 Interpretation and Implications of Varying Levels of Analytic Control Strong experimental control Problem Behavior per Min Interpretation: Implication: Sessions Test Control Have access to all reinforcers and EOs Can turn off problem behavior with reinforcement; should achieve meaningful outcome with only functionbased Rx

49 Interpretation and Implications of Varying Levels of Analytic Control Weak experimental control Problem Behavior per Min Interpretation: Implication: Sessions Test Control All reinforcers for problem behavior are not identified Variable responding will persist throughout skill development, probably necessitating punishment or arbitrary reward system The necessity of punishment when function-based treatments are made more practical is commonly reported: Fisher et al., 23, Hagopian et al.,1998, Hanley et al., 25, Wacker et al., 199

50 Towards a more controlled analysis Functional analysis format Standard Other Trial-based Brief Latency-based IISCA Single-test IISCA N = 456 N = 115 N = 21 N = 64 N = 6 N = 34 N = Percentage of applications with no weak moderate strong control

51 Let s compare. Standard Functional Analysis IISCA Number of differentiated analyses 5+ x 34 Social validation of assessment process x Social validation of derived Rx x Social validation of outcome x Efficiency x (average: 245 min) (average: 25 min) % of analyses with strong control x (26%) (92%)

52 But these conclusions are from literature reviews. Within-subject comparison is best next step.

53 Escape / Tangible Escape to Tangibles & Attention Differentiation SFA: 4 of 5 IISCA: 4 of 5 From Fisher et al., 216

54 Many believe that a standard functional analysis is a gold standard. Disagreement I think: Oh my. Oh my science.

55 Main assertion When there are different outcomes between two analyses, the one that has been around longer does not necessarily trump the findings of the other. The truth can be found in effective action. - Treatment effects - Speed of process - Acceptability/adoptability of practice

56 Slaton, J., Hanley, G., & Raftery, K. (216)

57 IISCA vs. Standard Analysis IISCA Standard IISCA 2 1 Test Control Escape to tangibles and attention Ignore/Alone Attention Tangible Escape Play Diego Problem behavior per min Escape to tangibles and attention Escape to tangibles Mason 1 Riley Sessions

58 IISCA vs. Standard Analysis IISCA Standard Problem behavior per min Test Control Escape to predictable schedule Escape to tangibles, stereotypy, and attention Alone Attention Tangible Escape Play Kyle Jonah Escape to tangibles and attention Sessions

59 IISCA vs. Standard Analysis 4 2 IISCA Test Control Ignore/Alone Attention Tangible Escape Play Standard Escape to tangibles Dylan Problem behavior per min 4 Escape to tangibles and attention 2 4 Escape to rituals 2 Emily 4 Escape to tangibles and attention 2 Chloe 1 Escape to tangibles Jeff Sessions

60 Treatment Comparison Results IISCA- based treatment Standard-based treatment Problem behavior per min BL Problem behavior BL FCT + EXT FCR FCT + EXT Escape to tangibles, attention Escape to tangibles BL BL FCT + EXT FCT + EXT Escape Emily Attention Jeff 5 1 Sessions 5 1

61 Treatment Comparison Results IISCA- based treatment Standard-based treatment Escape Problem behavior per min BL FCT + EXT Escape to tangibles Escape to rituals BL FCT + EXT Tangibles Dylan Escape 2 Chloe Sessions

62 Let s compare. Standard Functional Analysis IISCA Number of differentiated analyses 5+ x 34 Social validation of assessment process x Social validation of derived Rx x Social validation of outcome x Efficiency x (average: 245 min) (average: 25 min) % of analyses with strong control x (26%) (92%) Within-S comparison: % differentiated x (57%) (93%) Within-S comparison: % initial Rx success x (5%) (1%)

63 Let s compare. Standard Functional Analysis IISCA Number of differentiated analyses 5+ x 34 Social validation of assessment process x Social validation of derived Rx x Social validation of outcome x Efficiency x (average: 245 min) (average: 25 min) % of analyses with strong control x (26%) (92%) Within-S comparison: % differentiated x (57%) (93%) Within-S comparison: % initial Rx success x (5%) (1%)

64 The supposed problem(s) with the IISCA Imprecision Do not know the specific operant class to which any particular topography of problem behavior belongs. Do not know whether some part(s) of the synthesized contingency are irrelevant Do not know whether behavior is maintained by pos or neg sr Sometimes cannot neatly describe or compartmentalize the controlling variables Consider the effective action without knowing these things

65 Imprecision is not Unique to the IISCA Interpretive ambiguity from an IISCA Antecedent PB Consequence Interpretation No Attention / No tangible Attention / Tangible Behavior may be controlled by one, the other, or both Partly synthesized contingencies populate SFAs Interpretive ambiguity from an SFA Antecedent PB Consequence Interpretation No Attention / No tangible No Attention / Tangible Might be evoked by low attn. or lack of tangible, or both and maintained by attn. or tang or both Attention / No tangible Attention / Tangible Might be maintained by tangible or attention or both The supposed precision of a SFA is but an illusion

66 All models are wrong; the practical question is how wrong do they have to be to not be useful. Box & Draper, 1987, p. 424

67 Recognize the Historical Significance of the Standard Functional Analysis Moved us from behavior modification to behavior analysis Taught us our professional humility Inspired us to transcend description and prediction to control Allowed us to be scientific practitioners Showed us how to create stable and controlled baselines Allowed us to discover and enhance treatments

68 Multiple test conditions Uniform test conditions Isolated test contingencies Reinforce dangerous behavior only Toy-play control condition

69 To achieve the humane promise of a functionbased treatment and a socially valid outcome From a functional analysis: What can I safely infer? What must I know? What do I not need to know?

70 That which I can safely infer via my functional analysis: Response class membership

71 Problem Behaviors reported to co-occur (in order of concern) 1. SIB 2. Aggression 3. Disruptive Behavior 4. Disruptive vocalizations 5. Whining/complaining

72 This analysis shows all forms of problem behavior are evoked and maintained by same synthesized contingency. This happens every time we conduct this sort of analysis. (Warner et al., 216) This happens every time anybody else conduct this sort of analysis (Smith and Churchill, 22, Borrero & Borrero, 28, Herscovitch et al., 29)

73 That which I can safely infer via my Response class membership functional analysis: If parents or teachers report that other topographies of problem behavior precede or co-occur with the primary topography of problem behavior, they are likely to be maintained by the same reinforcers. I will infer response class membership and use their response to intervention (RTI) as verification

74 That which I must know via my functional analysis: That I can reliably turn problem behavior off with the presentation of the reinforcer(s) That I can reliably turn problem behavior on with the presentation of the evocative event (And that the reinforcers and evocative events were identified by other people relevant to the behaver)

75 That which I do not need to know via my functional analysis: The single operant function of each problem behavior Whether problem behavior is maintained by positive or negative reinforcement Whether some element of a synthesized contingency is a true contingency or merely a false positive

76 That which I do not need to know via my functional analysis: The single operant function of each problem behavior Whether problem behavior is maintained by positive or negative reinforcement Whether some element of a synthesized contingency is a true contingency or merely a false positive Whether I can neatly compartmentalize the operation in the analysis into a tidy generic class of reinforcement (e.g., social positive, social negative, attn, tang, esc, etc.)

77 My gold standard General and socially validated behavior change by relevant people in relevant contexts Baer, Wolf, & Risley, 1968 I achieve it by being able to turn on and off problem behavior in an analysis informed by caregivers.

78 For more information go to: Many thanks to my Practical Functional Assessment Research and Practice group: Nick Vanselow, Sandy Jin, Laura Hanratty, Joana Santiago, Mahshid Ghaemmaghami, Joshua Jessel, Jessica Slaton, Robin Landa, Christy Warner, Shannon Ward, Tanya Mouzakes Adithyan Rajaraman, Ellen Gage, Holly Gover, & Kelsey Ruppel Enjoy your weekend.

79 Work to be done 1. Teaching people how to discover relevant reinforcement contingencies via open-ended interviews 2. Teaching people how to design analyses from results of interviews 3. Determining a more systematic process for progressing from inconclusive to strongly differentiated analyses 4. Determining whether a valid treatment outcome can be obtained despite a sometimes unreliable process 5. Determining the probability of a socially valid outcome for heterogeneous groups of children who engage in severe problem behavior (i.e., RCT of the IISCA & skill-based treatment process)