DISSERTATION. the Degree of Doctor of Philosophy in the. Graduate School of The Ohio State University. Renee Koehler Van Norman, M.Ed.

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1 THE EFFECTS OF FUNCTIONAL COMMUNICATION TRAINING, CHOICE MAKING, AND AN ADJUSTING WORK SCHEDULE ON PROBLEM BEHAVIOR MAINTAINED BY NEGATIVE REINFORCEMENT DISSERTATION Presented in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy in the Graduate School of The Ohio State University By Renee Koehler Van Norman, M.Ed. * * * * * The Ohio State University 2005 Dissertation Committee: Professor Stephanie M. Peterson, Co-Adviser Professor Nancy A. Neef, Co-Adviser Susan N. Sherwood Approved by: Co-Adviser College of Education 1 Co-Adviser College of Education

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3 ABSTRACT The present study first investigated the effects of different qualities and durations of reinforcement for problem behavior, compliance, and communication within a treatment package for escape-maintained problem behavior. An ABA single-subject reversal design was used to experimentally evaluate the influence of quality and duration of reinforcement on 3-concurrently available response options. Next, the effects of this arrangement on participants response allocation were further evaluated under conditions in which work requirements were increased over time. The results of the choice analysis suggested that the different qualities and durations of reinforcement influenced participants response allocation between work and break choices, over that for problem behavior. The results of the second analysis showed substantial increases in compliance without concomitant increases in problem behavior as the number of demands was increased from 1 to 90. Relevant consumers opinions of the results and the acceptability of the FCT and choice making procedures employed in this study were favorable. This study extends the current literature on choice making and interventions for escape-maintained problem behavior by providing 3 different levels of reinforcement for 3 concurrently available response options: compliance, functional communication, and problem behavior. The majority of previously published studies evaluated different dimensions of reinforcement when only 2 response options were concurrently available. ii

4 In addition, this study provides preliminary evidence on the effects of combining FCT and demand fading under conditions in which problem behavior continues to receive reinforcement. iii

5 Dedicated to my husband, Keith iv

6 ACKNOWLEDGMENTS I would like to express my sincere appreciation to the members of my committee Drs. Stephanie M. Peterson, Nancy A. Neef, and Susan Sherwood. To my academic advisers, Drs. Stephanie Peterson and Nancy Neef, I am truly grateful for your support, encouragement, and patience. I am especially thankful for the many opportunities you have provided me throughout my doctoral studies. Thank you both for teaching me the meaning of Hakuna Matata. I would like to thank my outstanding research team. Without your countless contributions this dissertation would not have been possible: Traci Cihon, Ron Demuesy, Anjali Corattiyil, Jachelle Lowe, Denise Van Stone, and Katie Brennan. A special thank you goes to my participants, together we ve learned a great deal. I would like to express my sincere gratitude to Charlie Wood, Carrene Charbonneau, and Susan Silvestri. Keith and I are grateful for your friendship, support, and encouragement over the past few years. A special thank you goes to Dr. William Heward for his support of both Keith and I throughout the doctoral program. I would like to thank my family, Koehler and Van Norman for their unending encouragement. I would like recognize my parents who have continually provided me with outstanding models of how to be an extraordinary special educator. I am truly indebted to my husband and best friend, Keith Dutch Van Norman together, we re unstoppable. v

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8 VITA May 29, Born Paterson, New Jersey B.S. Psychology, Temple University Philadelphia, Pennsylvania Clinical Specialist, Seashore House Philadelphia, Pennsylvania Teaching Assistant, Princeton Child Development Institute Princeton, New Jersey M.Ed. Special Education, Temple University Philadelphia, Pennsylvania Graduate Assistant, The Ohio State University PUBLICATIONS Van Norman, R. K. (2006). Peer Tutoring Urban Elementary Kindergarten Students: Feature Teacher. In W.L. Heward and Charles L. Wood Exceptional teachers: Upper Saddle River, NJ: Prentice Hall/Merrill. A CD-ROM video to accompany W. L. Heward s Exceptional children: An introduction to special education (8th ed.). Van Norman, R.K. & Lown, K. (2006). Will work for beans : Classroom management program: Feature Teacher. In W.L. Heward and Charles L. Wood Exceptional teachers: Upper Saddle River, NJ: Prentice Hall/Merrill. A CD-ROM video to accompany W. L. Heward s Exceptional children: An introduction to special education (8th ed.). Peterson, S. M., Neef, N. A., Van Norman, R. K., & Ferrari, S. (2005). Choice making in educational settings. In W. L. Heward, T. E. Heron, N. A. Neef, S. M. Peterson, D. M. Sainato, G. Cartledge, R. Gardner III, L. D. Peterson, S. B. Hersh, & J. C. Dardig (Eds.), Focus on Behavior Analysis in Education: Achievements, challenges, and opportunities. Upper Saddle River, NJ: Prentice Hall/Merrill. ii

9 FIELDS OF STUDY Major Field: Education Special Education ii

10 TABLE OF CONTENTS Page Abstract...ii Acknowledgments...v List of Tables... viii List of Figures...xi Chapters 1. Introduction... 1 Purposes of the Study Review of the Literature... 8 Operant Reinforcement and Problem Behavior Positive Reinforcement Functions Negative Reinforcement Functions Automatic Reinforcement Functions Assessment of Operant Functions of Problem Behavior Summary Consequence-Based Treatment Options for Escape-Maintained Problem Behavior 13 Extinction Definition and Procedural Description of Extinction Strengths of extinction Limitations of extinction Differential Reinforcement Definition and Procedural Description of Differential Reinforcement 17 Definition and Procedural Description of DRO Strengths of differential reinforcement of other behavior Limitations of differential reinforcement of other behavior...20 Definition and Procedural Description of DRA Definition and Procedural Description of DRA Compliance Strengths of DRA Compliance Limitations of DRA Compliance...24 iii

11 Definition and Procedural Description of DRA Communication. 25 Strengths of FCT Limitations of FCT Definition and Procedural Description of DRA Plus Demand Fading 29 Strengths of DRA plus demand fading Limitations of DRA plus demand fading Summary Conceptual Framework for Choice Making Dimensions of Reinforcement Summary Competition Between Problem Behavior and Alternative Behavior Summary of Literature Research Questions Method Participants Carl Ian Charlie Setting Experimenter Data Collectors Materials Electronic Equipment Edible Items and Other Toys Alternative Communication Systems Instructional, Vocational, and Other Materials Definition and Measurement of Dependent Variables Definitions and Measurement of Overall Problem Behaviors Aggression Throwing Dropping Mouthing Vomiting Definition and Measurement of Independent Requests Break Requests Work Requests Definition and Measurement of Choices Definition and Measurement of Other Break Requests Definition of and Measurement of Compliance Experimental Design Choice Analysis Demand Fading iv

12 Procedures Phase 1: Pre-study Assessments Functional Behavior Assessment Functional assessment interview ABC assessments Preference Assessments Functional Analysis Functional Communication Training Pre-FCT Task Assessment FCT-Break Request Training FCT-Work Request Training Phase 2: Experimental Analyses Choice Analysis Work=HQR Break = HQR Return to Work=HQR Demand Fading Interobserver Agreement Recruitment and Training of Secondary Observers for Interobserver Agreement (IOA) Procedures for Collecting Interobserver Agreement (IOA) Data Procedural Integrity Measures Recruitment and Training of Procedural Integrity Evaluators Procedures for Measuring Procedural Integrity Social Validity Measures Procedures for Measuring and Calculating Intervention Acceptability Procedures for Measuring and Calculating Social Impact of Results Results Phase 1: Pre-Study Assessments Functional Behavior Assessment Functional Assessment Interview ABC Assessments Carl Ian Charlie Preference Assessments Functional Analysis Carl Ian Charlie Functional Communication Training FCT Break and Work Request Training v

13 Carl Ian Charlie Phase 2: Experimental Analyses Choice Analysis Carl Ian Charlie Demand Fading Carl Ian Interobserver Agreement (IOA) Functional Analysis FCT Break and Work Request Training Choice Analysis Demand Fading Procedural Integrity Measures Social Validity Intervention Acceptability Social Impact of Results Discussion Research Questions Research Question Research Question Research Question Limitations and Future Research Implications for Practice Summary and Contributions List of References Appendices: A: Informational Letter and Consent Form B: Letter of Support, Permission to Conduct Research, and FCBMR/DD And OSU IRB Approval Letter C: Sample Data Sheets D: Blank Functional Analysis Interview Form and ABC Assessment Form vi

14 E: Sample Preference Assessment Datasheets F: Secondary Observer Recruitment Letter and Description of Research G: Samples of Blank And Completed Procedural Integrity Datasheets and Directions for Scoring H: Blank TARF and Social Validity Survey Forms I: Copy of Consent Form for Participation in Social Validity Measures J: Sample of a Completed Social Validity Survey vii

15 LIST OF TABLES Table Page 3.1 Dependent variables, their subcategories, and measurement system Reinforcement contingencies associated with Phase 1: Pre-Study Assessments and Phase 2: Experimental Arrangements Method, materials, and number of initial preference assessments conducted for each participant Consequences for behavior during functional analysis conditions Contingencies applied during FCT Break Request Training Contingencies applied during FCT Work Request Training Contingencies applied during Work = HQR Contingencies associated with Break = HQR Contingencies associated with Work = HQR plus demand fading Functional analysis interview results Preference assessment results for all participants Percent of sessions with interobserver agreement calculations across participants and experimental conditions Percent interobserver agreement for aggression across each functional analysis condition for Carl Percent interobserver agreement for throwing across all functional analysis conditions for Carl Percent interobserver agreement for mouthing across all functional analysis conditions for Carl viii

16 4.7 Percent interobserver agreement for dropping across all functional analysis conditions for Carl Percent interobserver agreement for throwing across all functional analysis conditions for Ian Percent interobserver agreement for dropping across all functional analysis conditions for Ian Percent interobserver agreement for aggression across all functional analysis conditions for Ian Percent interobserver agreement for throwing across each functional analysis condition for Charlie Percent interobserver agreement across all measures of problem behavior during FCT for all participants : IOA across all measures of independent requests for all participants during FCT Percent interobserver agreement across all choice measures for each participant during the choice analysis Percent interobserver agreement across all measures of problem behavior for each participant during the choice analysis Percent interobserver agreement across measures of problem behavior for Carl and Ian during demand fading Percent interobserver agreement across all choice measures for each Carl and Ian during demand fading Percent interobserver agreement across all task demand, compliance, and other break request measures for Carl and Ian during demand fading Overall procedural integrity scores (means and ranges) across FCT Break and Work Request Training, Choice Analysis, and Demand Fading Intervention acceptability rating scores Intervention acceptability rating scores by dimension of intervention acceptability across all participants, where 1 = not at all acceptable and 7= very ix

17 acceptable Social validity survey results (means and ranges) per question across all respondents, where 1=strongly disagree and 5 = strongly agree x

18 LIST OF FIGURES Figure Page 3.1 Schematic of session room used for Carl Schematic of the session room used for Ian and Charlie Photos of electronic video recording and timing equipment Photos of additional electronic materials Photos of edible items and other toys Photos of alternative communication systems Photo of lunch tray assembly instructional materials Photos of vocational instructional materials Arrangement of choice materials (break and work choice) and MQR & HQR Diagram illustrating the reinforcement contingencies associated with Work = HQR plus demand fading Percent of 10-s intervals with problem behavior Number of break and work requests and percent of 10-s intervals with problem behavior (overall) during FCT-Break and Work Request Training for Carl Number of break and work requests and percent of 10-s intervals with problem behavior (overall) during FCT-Break and Work Request Training for Ian Number of break and work requests and percent of 10-s intervals with problem behavior during FCT-Break and Work Request Training for Charlie Percentage of work, break, and problem behavior choices and percentage of 10-s intervals with problem behavior during Carl s Choice Analysis xi

19 4.6 Percentage of work, break, and problem behavior choices and percentage of 10-s intervals with problem behavior during Ian s Choice Analysis Percentage of work, break, and problem behavior choices and percentage of 10-s intervals with problem behavior during Charlie s Choice Analysis Percentage of choices (work, break, and problem behavior), percentage of 10-s intervals with problem behavior (overall), number of demands, and compliant responses during Carl s Demand Fading Percentage of choices (work, break, and problem behavior), percentage of 10-s intervals with problem behavior (overall), number of demands, and compliance during Ian s Demand Fading xii

20 CHAPTER 1 INTRODUCTION Educators working with individuals who have moderate to severe developmental disabilities and limited communication skills face many challenges in the classroom. One of the issues teachers face in their endeavors to educate students with severe developmental disabilities is the occurrence of a variety of problem behaviors labeled as noncompliance, work refusals, or disruptions (Marcus & Vollmer, 1995). Noncompliance to task requests may take many forms, such as aggression, self-injury, verbal and/or physical refusal and can directly impact a student s meaningful and active participation in academic and functional instruction. Functional communication training (FCT) has attracted much attention from individuals working with students who engage in escape-motivated problem behavior (see Wacker & Reichle, 1993). FCT involves teaching an individual a more appropriate way to communicate that he/she wants to take a break so that problem behavior is no longer necessary to communicate this desire. At the same time, reductive techniques, such as no longer allowing escape for problem behavior (i.e., a procedure known as extinction), are employed. Although several studies have provided empirical 1

21 evidence for the efficiency and effectiveness of FCT as a treatment option for escapemaintained problem behavior, there remain some unresolved issues that affect its utility within classroom settings. Several studies have demonstrated that the effects of a FCT treatment program might be compromised when reductive consequences, such as extinction, are not applied or are applied inconsistently (Kelly, Lerman, & Van Camp, 2002; Shirley, Iwata, Kahng, Mazaleski, & Lerman, 1997). Even if extinction is applied consistently and systematically, side effects such as extinction bursts or extinction induced aggression may affect the utility of FCT packages within applied settings (Lerman, Iwata, & Wallace, 1999). That is, the problem behavior often gets worse before it gets better when extinction is used. In addition, there may be circumstances within applied settings in which extinction for problem behavior may not be possible due to the severity or life threatening nature of the behavior (Holden, 2002; Peck et al., 1996). Under these circumstances, where both problem behavior and appropriate behavior (e.g., break requests) produce negative reinforcement in the form of escape from instructional demands, an FCT program may result in treatment failure (Hagopian, Fisher, Sullivan, Acquisto, & LeBlanc, 1998). As a result of these limitations on the feasibility of extinction procedures for escape maintained problem behavior reinforcement for problem behavior may continue and the outcome of the program is [then] determined by the competition between reinforcement of appropriate behavior (e.g., mand/compliance) and problem behavior (Holden, 2002, p. 193). 2

22 In addition to the possibility of extinction bursts, FCT often produces a substantial increase in the students requests for breaks in the presence of task demands (Marcus & Vollmer, 1995). For example, one effect that may occur when using a FCT program as a treatment option for noncompliant behavior maintained by escape is that the individual may begin to request breaks at such a high rate that the treatment interferes with his/her instructional programming. For example, if a student is taught to mand for a break in the presence of instructional demands, he or she may continually request breaks and no longer participate in meaningful instructional activities. Although the problem behavior may decrease to acceptable levels, the individual loses time building a repertoire of other important skills. As suggested by Lalli and colleagues (1995), for FCT to be an effective treatment for problem behavior maintained by escape from task demands, practitioners must use FCT in a way that can maintain the suppression of problem behavior while also improving participation in instruction. Practitioners have attempted to address this limitation by implementing differential reinforcement of alternative behaviors (DRA) -- that is, differentially reinforcing compliance while placing problem behavior on extinction. During the application of this intervention, individuals essentially have two choices: (1) comply with the task demand or (2) engage in problem behavior. Similar to a typical FCT program, the success of a DRA intervention largely depends upon the feasibility of implementing an extinction procedure for problem behavior. Several researchers have attempted to increase the utility of DRA as a treatment to decrease problem behavior and maintain engagement by thinning the schedule of reinforcement and increasing demands over time 3

23 (e.g., Hanley, Iwata, & Thompson, 2001; Zarcone, Iwata, Smith, Mazaleski, & Lerman, 1994). One problem encountered with such interventions, however, is that bursts of problem behavior are often observed when work requirements are increased (see Zarcone et al., 1994). Thus, the success of adjusting the work requirements and, in turn, thinning the schedule of reinforcement appears to be predicated on the application of extinction for problem behavior (Hagopian et al., 1998). In cases in which extinction is not a viable component for intervention (e.g., the behavior is too dangerous), problem behavior must continue to receive some reinforcement. As noted by Holden (2002), the individual then has two avenues for accessing reinforcement: through appropriate communication and via problem behavior. Thus, the individual may have a choice of responses for gaining access to reinforcers. As interventionists, the relevant task is to influence the individual s choices toward the more appropriate (i.e., communicative) response. As shown by Neef, Mace, Shea, and Shade (1992), Neef, Mace, and Shade (1993), Neef, Shade, and Miller (1994), Neef and Lutz (2001), and Peck et al. (1996), choices between concurrently available response options can be influenced by changing various dimensions of reinforcement. The various dimensions of reinforcement that operate on an individual s choice among concurrently available response options can include: the rate of reinforcement, the immediacy to reinforcement, the quality of reinforcement, the duration of reinforcement, and any combination of these dimensions (Peterson, Neef, Van Norman, & Ferreri, 2005). These dimensions of reinforcement that are operating on all available response options influence the choice an individual emits at any given moment. 4

24 Studies based on the matching theory (e.g., Horner & Day, 1991; Peck et al., 1996; Richman, Wacker, & Winborn, 2001) provide one direction to identify how these variables affect the utility and success of treatment programs using FCT. An assumption of the matching theory is that all behaviors take place within a context where a variety of reinforcers are also available for other behaviors (Holden, 2002) and that most behavior can be viewed as choice; that is, doing one thing to the exclusion of doing something else (Peterson et al., 2005). For example, within typical classroom environments, students may display a variety of problem behaviors. Within these environments, compliance to task requests and problem behavior may contact different qualities and durations of reinforcement. For example, problem behavior may result in high quality adult attention in the form of a crisis intervention technique (e.g., a basket hold) for a long duration (e.g., until the student is calm) whereas compliance to task requests may result in additional task requirements. In such situations (in which problem behavior is maintained by escape from task demands) the procedures described in the previous example may actually bias responding in favor of problem behavior rather than appropriate behavior (e.g., compliance). The matching theory allows us to describe and, in some situations, predict response allocation under different schedules of reinforcement. The research on matching theory as it relates to problem behavior tells us individuals behavior is sensitive to different dimensions of reinforcement (Fisher & Mazur, 1997; McDowell, 1988; Mace & Roberts, 1993). However, most studies of matching theory and response allocation have 5

25 been conducted in which only two response options have been available (e.g., problem behavior and one alternative response or two appropriate responses, such as completing an easy math problem versus a difficult math problem). There is little research on how responses are allocated across 3 response options when 3 different qualities and durations of reinforcement are provided. Also, although it has been shown that mands can effectively compete with problem behavior if they receive higher quality/longer duration of reinforcement (e.g., Peck et al., 1996), individuals will often mand continuously for reinforcement (Marcus & Vollmer, 1995). As an alternative, some researchers teach task compliance as the alternative response rather than mands (i.e., DRA procedure), while slowly increasing work requirements (Zarcone et al., 1994). However, this often results in increased problem behavior when work requirements are increased. Combining two interventions (FCT and DRA with increasing work requirements) within a 3-choice scenario may provide an effective solution to both issues. Specifically, understanding the different factors that influence choice -- for example between problem behavior, mands, and compliance -- may help to better predict the effectiveness of FCT treatments for individuals who engage in problem behavior maintained by negative reinforcement. Purposes of the Study The purposes of this study were to (a) evaluate the participants sensitivity to different dimensions of reinforcement within a choice analysis (i.e., quality and duration) associated with 3 concurrently-available response alternatives (e.g., requests for work, requests for breaks, and problem behavior) during intervention for severe problem 6

26 behaviors maintained by negative reinforcement; and (b) evaluate the effects of systematic increases in work requirements on work requests, problem behavior, break requests, and task completion. 7

27 CHAPTER 2 REVIEW OF THE LITERATURE Noncompliance or task refusals exhibited by students during academic instruction can impede social and academic growth (Dube & McIlvane, 2002). Negative reinforcement (escape/avoidance) maintains a large percentage of noncompliant behavior (see Iwata et al., 1994 and Derby et al., 1992 for reviews). Therefore, the assessment and treatment of this class of behaviors remain an important topic for investigation (Marcus & Vollmer, 1995). In order to understand the assessment methodologies for problem behaviors maintained by negative reinforcement, an understanding of operant reinforcement and its relation to problem behavior is necessary. Operant Reinforcement and Problem Behavior Operant reinforcement describes a functional relationship between behavior and environment (Catania, 1998). Reinforcement is a principle of behavior and is defined by its effect on behavior. The description of the relation between behavior and consequences includes three elements. First, the behavior occurs and is followed by consequences. Second, there is an increase in the probability of the behavior occurring in the future under similar environmental conditions. Finally, the increase in the occurrence of 8

28 behavior must occur because of the consequences that followed and not for other reasons (Catania, 1998) such as unspecified mental activities. An item, event, or activity is considered a reinforcer when its contingent presentation or removal as a consequence increases the probability of the behavior in the future. There are three broad classes of reinforcement: positive, negative, and automatic reinforcement. When considering these classes of reinforcement in relation to problem behavior, Carr (1977) postulated that problem behavior can serve different functions: a positive reinforcement function, a negative reinforcement function, and/or an automatic function. The importance of determining reinforcement contingencies maintaining problem behavior prior to treatment was first conceptualized by Carr. Positive Reinforcement Functions Positive reinforcement is defined as the contingent presentation of preferred items or events. Problem behaviors, for example, spitting and aggression, can be maintained by adult attention or preferred items that follow their occurrence. Positive reinforcement has been shown to maintain problem behavior in anywhere from 21% to 83% of cases (Derby et al., 1992; Iwata et al. 1994; Wacker et al., 1998). Positive reinforcement can also maintain a variety of problem behaviors, such as self-injury and aggression (Carr & McDowell, 1980; Derby et al., 1992; Fisher, DeLeon, Rodriquez-Catter, & Keeney, 2004; Hanley, Piazza, & Fisher, 1997; Iwata et al., 1994; Piazza et al., 1999; Thompson, Fisher, Piazza, & Kuhn, 1998). For example, Fisher, Ninness, Piazza, and Owen-DeSchryver (1996) conducted an assessment to determine the operant function of destructive behavior displayed by an 9

29 individual with autism and oppositional defiant disorder. The results showed higher levels of destructive behavior when the statement, Don t hit me, was delivered contingent on problem behavior as compared to lower levels when a neutral or no statement was made. Similarly, Mueller, Wilczynski, Moore, Fusilier, and Trahandt (2001) demonstrated a functional relationship between a young boy s aggressive behavior and access to preferred books and toys. The results showed higher levels of aggressive behavior when books and toys were provided contingent on problem behavior as compared to lower levels of aggression when attention and toys or demands were present. Negative Reinforcement Functions Negative reinforcement is defined as the contingent removal or termination of aversive conditions (escape) and the prevention of aversive events (avoidance). Problem behaviors can be maintained by the contingent removal of task demands (aversive conditions) or by the avoidance of task demands. In fact, negative reinforcement contingencies have been shown to account for anywhere between 38% and 82% of problem behaviors (Derby et al., 1992; Iwata et al., 1994). Negative reinforcement has been shown to maintain a variety of problem behaviors, such as throwing objects and destroying materials (Cooper et al. 1992; DeLeon, Neidert, Anders, & Rodriquez-Catter, 2001; Derby et al., 1997; Hagopian, Wilson, & Wilder, 2001; Iwata, Pace, Cowdery, & Cataldo, 1990; Shukla & Albin, 1996). For example, Lerman, Kelley, Vorndran, Kuhn, and LaRue (2002) demonstrated a negative reinforcement function for the aggression and disruption displayed by 2 participants with severe disabilities. The results of the study showed higher levels of 10

30 problem behavior when the participants received a break following occurrences of problem behavior relative to when preferred toys and attention were freely available. Similarly, Harding et al. (1999) showed the effects of negative reinforcement on the task refusals (crying, screaming) exhibited by two 4-year-old participants. Automatic Reinforcement Functions Automatic reinforcement is defined as the contingent presentation of a preferred stimulus (sensory input) or the contingent removal of an aversive stimulus (sensory regulation) delivered independent of social consequences (Chandler & Dahlquist, 2002; Ellington et al., 2000; Repp, 1999; Shore & Iwata, 1999). Automatic reinforcement functions are demonstrated by the persistence of behavior under conditions where no programmed consequences are delivered, when the individual is alone, and/or across many different environmental contexts. Problem behaviors, such a self-injury (SIB) and the ingestion of inedible items (pica), can be maintained by the contingent effects of the behavior itself (Piazza, Roane, Keeney, Boney, & Abt, 2003; Shore, Iwata, DeLeon, Kahng, & Smith, 1997). Automatic reinforcement functions have been demonstrated to maintain problem behavior in anywhere from 26% to 63% of cases (Derby et al., 1992; Iwata et al., 1994). Automatic reinforcement contingencies have been shown to maintain a variety of problem behaviors, such as SIB and pica (Hagopian & Adelinis, 2001; Piazza, Adelinis, Hanley, Goh, & Delia, 2000; Piazza et al., 2002; Roscoe, Iwata, & Goh, 1998; Shore, Iwata, DeLeon, Kahng, & Smith, 1997). 11

31 For example, Piazza et al. (2002) demonstrated an automatic reinforcement function for pica displayed by 3 individuals with severe mental retardation. The results of the study showed high rates of pica with undifferentiated response patterns across 4 different experimental arrangements. All 3 participants exhibited pica in the absence of social consequences and when they were alone for an extended period of time. Collectively, these results suggested an automatic reinforcement function for the pica exhibited by these participants. Assessment of Operant Functions of Problem Behavior Iwata, Dorsey, Slifer, Bauman, and Richman (1982/1994) developed an assessment technology to evaluate the effects of various environmental conditions on problem behavior. First Iwata et al. (1982/1994) identified and defined the problem behavior (SIB) and then reinforced the occurrence of SIB under alternating conditions of positive and negative reinforcement. The results of the assessment were analyzed within a single-subject multielement design (Kazdin, 1982) to determine if there were functional relationships between problem behavior and environmental events. The results showed that operant functions can be identified through careful manipulation of both the positive and negative reinforcement provided contingent upon the occurrence of problem behavior. This seminal research provided a systematic assessment methodology for identifying positive, negative, and automatic reinforcement functions for problem behavior. Although the idea that problem behavior is controlled by environmental events was not new (Skinner, 1970), Iwata et al. (1982/1994) provided a framework from which functional relationships between behavior, such as noncompliance, and negative 12

32 reinforcement, such as escape from demands could be demonstrated. Since then many researchers have used this technology and other experimental arrangements to identify the operant functions of a variety of problem behavior. Summary Functional analysis research has demonstrated positive, negative, automatic and multiple reinforcement functions for a variety of problem behaviors. When the operant function of problem behavior has been identified, function-based treatment options can be selected and implemented to increase the occurrence of socially acceptable behavior, while simultaneously decreasing problem behavior (Vollmer & Iwata, 1992). Due to the prevalence of escape-maintained problem behaviors presented for evaluation and treatment (see Derby et al., 1992; Iwata et al., 1994;Wacker et al., 1998 for reviews), many researchers have investigated the effects of a variety of treatment options on the occurrence of this class of problem behavior (see Iwata, 1987 for a review). The present study focuses primarily on problem behaviors maintained by escape; therefore, the remainder of this chapter will discuss only consequence-based treatment options for escape-maintained problem behavior. Consequence-Based Treatment Options for Escape-Maintained Problem Behavior Consequence-based treatment options for escape-maintained problem behaviors include, but are not limited to, the discontinuation of ongoing reinforcement for problem behavior (extinction/ext) and the differential reinforcement (DR) of other (DRO) and alternative behavior (DRA and FCT). There are also other effective antecedent-based and consequence-based interventions that have been successful in reducing escape- 13

33 maintained problem behavior (see Cipani & Spooner, 1997 for a review); however, they are tangential to the present study and beyond the scope of this chapter. Extinction Definition and Procedural Description of Extinction Extinction (EXT) is defined as the discontinuation of reinforcement for a previously reinforced response (Cooper et al., 1987). The implementation of EXT requires the discontinuation of the response-reinforcer relationship between problem behavior, such as task refusals, and negative reinforcement, such as a break from demands (Harding et al., 1999). EXT procedures can be implemented either with or without physical interaction. Physical interaction EXT procedures are implemented by blocking or guiding the individual to complete the task, thereby no longer providing negative reinforcement for problem behavior (Iwata et al., 1994, Piazza, Moes, & Fisher, 1996). Non-physical EXT procedures are implemented by continual verbal prompting to complete a demanding task and non-removal of the aversive stimuli (Piazza et al., 1996). The effect of EXT procedures on escape-maintained problem behaviors have resulted in gradual reductions in problem behavior over time. For example, Goh and Iwata (1994) treated the escape-maintained SIB and aggression displayed by an individual with developmental disabilities using an EXT procedure. During the EXT condition, the experimenter used a 3-prompt hierarchy (model, verbal, then physical instruction) to engage the participant in the task. The experimenter provided praise contingent on compliance. All aggression was blocked, and SIB resulted in physical prompting to engage in the task. The results showed gradual 14

34 and variable reductions in problem behavior following an initial increase in the occurrence of SIB. The results of this study suggested that EXT could be used effectively to reduce problem behavior; however the reductions in problem behavior can be expected to be relatively gradual over time as the response-reinforcer relationship becomes extinguished (Goh & Iwata, 1994; Iwata, Pace, Kalsher, Cowdery & Cataldo, 1990). Strengths of extinction. The primary strength of EXT is its effectiveness in reducing problem behavior (Carr, Newsom, Crighton, & Binkoff, 1980; Pace, Iwata, Cowdery, Adree, & McIntyre, 1993; Piazza, Patel, Gulotta, & Layer, 2003; Richman, Wacker, Asmus, & Casey, 1998; Zarcone, Iwata, Hughes, & Vollmer, 1993; Zarcone, Iwata, Vollmer et al., 1993). EXT frequently results in the desired suppression of problem behavior, and this suppression is durable over time if EXT is maintained (Iwata, Pace, Cowdery, & Miltenberger, 1994). For example, Iwata et al. (1990) used EXT to treat SIB maintained by negative reinforcement for 6 individuals. The EXT procedure was implemented using physical guidance and continual presentation of task demands contingent on problem behavior. The results showed substantial decreases to near zero levels in the display of SIB and concomitant increases in compliance when problem behavior no longer contacted negative reinforcement. This study illustrated that reductions in problem behavior, resulting from the use of an EXT procedure, can also affect socially desirable behaviors, such as compliance. 15

35 Limitations of extinction. Although an effective behavior reduction procedure for escape-maintained problem behavior, EXT procedures also have several limitations. When used in isolation EXT procedures can produce a number of side effects, such as initial increases in the rate and magnitude of problem behavior, referred to as an EXT burst (Cooper et al., 1987; Iwata et al., 1990; see Lerman & Iwata, 1995; Lerman & Iwata, 1996; Lerman et al., 1999), or persistence of the problem behavior over time (e.g., resistance to EXT; Cooper et al., 1987). Lerman et al. (1999) reviewed 41 cases in which EXT was used as the primary behavior reduction procedure. The results of their analysis revealed side effects, such as EXT bursts or EXT-induced aggression in 40% of the cases reviewed. The results of their analysis also showed higher prevalence of EXT bursts when EXT was used to treat problem behavior maintained by negative reinforcement versus when EXT was used to treat problem behavior maintained by positive reinforcement (Lerman et al., 1999). Initial increases in problem behavior can pose several limitations on the utility of EXT as a treatment option for escape-maintained problem behavior. Specifically, if the severity of the problem behavior becomes too great it may be unsafe for a care provider or parent to implement EXT. In addition, if the problem behavior becomes worse before it is reduced, implementers of an EXT program may simply give up and no longer withhold reinforcement. The prevalence of EXT bursts and EXT induced aggression has been addressed in the literature as a major limitation on the use of EXT as a viable treatment option for problem behavior. An additional limitation of EXT as a practical treatment option for escapemaintained behavior is the gradual versus rapid reduction in problem behavior that often 16

36 results when EXT is initially implemented. As demonstrated in the Goh and Iwata (1994) study, EXT can produce gradual and variable reductions in problem behavior (e.g., resistance to EXT), which are especially difficult when the problem behavior is so severe that immediate reductions in problem behavior are needed. To be effective, EXT procedures should be implemented consistently and precisely (Cooper et al., 1987). The consistent application of EXT may be limited if the individual is especially large and/or strong, and if problem behavior is especially severe (Pace, Ivancic, & Jefferson, 1994; Peck et al., 1996; Peck Peterson et al., 2005; Piazza et al., 1996; Piazza et al., 1997). Specifically, it may be impossible for a smaller, weaker individual to ensure that a larger, stronger individual, who is engaging in problem behavior, continues to receive task demands. Another major limitation of EXT procedures is that they do not have programmed reinforcement contingencies in place for more adaptive responding, such as compliance. Therefore, the building of new behaviors and strengthening of compliance over time may not occur. Differential Reinforcement Definition and Procedural Description of Differential Reinforcement Due to the limitations of EXT procedures and to increase the chances of building more desirable behaviors, EXT procedures have been combined with reinforcement procedures (Lerman et al., 1999). In fact, Lerman et al. (1999) reported substantial decreases in the prevalence of EXT induced aggression and EXT bursts when EXT was combined with other reinforcement procedures. One of these procedures is differential 17

37 reinforcement (DR). Differential reinforcement is defined as the contingent application of reinforcement for one behavior, while simultaneously withholding reinforcement (EXT) for other behaviors (Cooper et al., 1987). Two major differential reinforcement procedures widely used for escapemaintained problem behavior include, but are not limited to: differential reinforcement of other behavior (DRO) and differential reinforcement of alternative behavior (DRA) (Lennox, Miltenberger, Spengler, & Erfanian, 1988). DRO is a schedule of reinforcement that focuses on the nonoccurrence of the problem behavior, while DRA procedures focus on the occurrence of functional alternatives to the problem behavior (Cooper et al., 1987). When the alternative behavior selected for differential reinforcement is a communication response, DRA procedures are also referred to as functional communication training (FCT; Carr & Durand, 1985). All DR procedures discontinue reinforcement for problem behavior by implementing an EXT component. DR procedures have been cited as the most commonly used behavior reduction procedures for individuals with developmental disabilities (Lennox et al., 1988; Vollmer & Iwata, 1992). Definition and Procedural Description of DRO DRO involves the delivery of reinforcement contingent on the nonoccurrence of the target behavior for a predetermined time interval (Cooper et al., 1987; Vollmer & Iwata, 1992). Therefore, reinforcement typically follows any other behavior that is not targeted for reduction (Cooper et al., 1987). There are a number of procedural variations of DRO that specify the restrictions on the occurrence of the target behavior in relation to 18

38 the length of the time interval. The duration of the DRO time interval can be fixed (e.g., FI 30s) or variable (e.g., VI 30s). The delivery of reinforcement can be contingent upon the absence of the target behavior for the entire interval (whole-interval DRO) or contingent upon the absence of the target behavior at the moment the interval elapses (momentary-dro). Contingent upon problem behavior, the time interval can be reset to zero (resetting DRO) or allowed to elapse (non-resetting DRO). DRO procedures have been used to reduce a variety of escape-maintained problem behaviors, such as property destruction and self-injury (Kodak, Miltenberger, & Romaniuk, 2003a/b; Nolley, Butterfield, Fleming, & Miller, 1982; Roberts, Mace, & Daggett, 1995). For example, Kodak et al. (2003a) demonstrated the suppression of inappropriate vocalizations and destructive behavior exhibited by a 7-year-old female using a resetting DRO procedure. During the DRO condition, the participant was instructed to engage in an academic task. Contingent upon the absence of problem behavior for 10 s, the participant was given access to a 50-s break plus attention in the form of praise. The break time was then reduced to 10s, and the DRO time interval increased to 1min. Contingent on problem behavior, the therapist reset the clock to 10s. The results showed substantial reductions in problem behavior and collateral increases in other positive behavior. The results of this study suggest the effects of a DRO procedure can produce substantial reductions in problem behavior and concomitant increases in other behavior as reinforcement is withheld for the occurrence of problem behavior and is delivered contingent on any other appropriate behavior. 19

39 Strengths of differential reinforcement of other behavior. A significant strength of DRO procedures is their effectiveness in reducing problem behavior (see Lindberg, Iwata, Kahng, & DeLeon, 1999; Vollmer & Iwata, 1992 for reviews). The increase in reinforcement for other behavior and discontinuation of reinforcement for problem behavior can result in rapid decreases in problem behavior (Cooper et al., 1987). For example, Lindberg et al. (1999) showed substantial decreases in the SIB exhibited by 3 adults with severe mental retardation using a DRO procedure. The DRO procedure included the discontinuation of reinforcement for SIB, while reinforcement was delivered for the absence of behavior on a fixed, variable, or variable momentary DRO schedule of reinforcement. The DRO intervention resulted in dramatic and immediate decreases in problem behavior for both participants under each procedural variation of DRO. Another strength of DRO procedures are that DRO procedures are usually inexpensive to maintain (Barker & Thyer, 2000) and relatively easy to implement. Because the delivery of reinforcement is not contingent on a pre-selected alternative behavior, individuals implementing the procedure do not have to wait for an alternative behavior to occur to deliver reinforcement (Cowdery, Iwata, & Pace, 1990). Specifically, when using a momentary-dro procedure, a teacher could conduct a brief check for the occurrence/nonoccurrence of a targeted problem behavior for one student at the moment a time interval elapses, while simultaneously engaging in other instructional activities. Limitations of differential reinforcement of other behavior. Despite the positive effects DRO procedures can have on reducing many challenging behaviors, there are some issues that may limit the effectiveness of DRO as an intervention technique for 20

40 escape-maintained problem behavior (Mazealeski, Iwata, Vollmer, Zarcone, & Smith, 1993). Although DRO procedures may be relatively easy to implement because delivery of the reinforcer is not contingent on a specific replacement behavior; DRO procedures still require a great deal of monitoring to insure the absence of the target behavior (Reed et al., 2005).. Similar limitations that impede the success of EXT used in isolation may impede the success of DRO. For example, if escape-maintained problem behaviors occur at such a high rate that the individual does not come into contact with the reinforcement contingencies associated with the DRO procedure, side effects such as EXT bursts or emotional responding may occur (Lerman et al., 1999). If these negative behaviors are too severe and EXT cannot be implemented, then the effects of DRO may be limited. In addition, DRO does not teach new replacement behaviors for problem behavior. The time-based schedule and delivery of reinforcement contingent on the absence of behavior limits the procedure s effect on building functionally equivalent alternative behaviors (LeBlanc, Hagopian, Maglieri, & Poling, 2002). Although, the time-based delivery of reinforcement may produce some collateral increases in appropriate behaviors, as demonstrated in the Kodak et al. (2003a) study; these occur only through adventitious reinforcement and by happenstance. Due to these limitations, many researchers have investigated the effects of selecting and reinforcing a specific replacement behavior while simultaneously withholding reinforcement for the problem behavior. 21

41 Definition and Procedural Description of DRA Differential reinforcement of alternative behavior (DRA) is the combined application of EXT for problem behavior and the contingent reinforcement of a specific alternative behavior (Cooper et al., 1987). Both DRA and its procedural variation, FCT, have been shown to decrease a variety of escape-maintained problem behaviors, while simultaneously increasing socially acceptable behaviors (e.g., Piazza et al., 1996; Reed et al., 2005; Ringdahl et al., 2002; Vollmer et al., 1999; see Wacker, Peck, Derby, Berg, & Harding, 1996). Due to the breadth of literature supporting both DRA and its procedural variation FCT as consequence-based treatment options for escape-maintained problem behavior, the definition, procedural description, strengths, and limitations of each will be presented under separate headings: DRA - Compliance and DRA - Communication, respectively. Definition and Procedural Description of DRA Compliance Differential reinforcement of alternative behavior - compliance combines EXT with the contingent application of reinforcement for socially acceptable alternatives to noncompliant behaviors (Cooper et al., 1987). Compliant behaviors have been defined in the literature as various forms of engagement, for example, toy engagement defined as the manipulation of play materials following instructions (e.g., Harding et al., 1999), task engagement, defined as the manipulation of instructional materials following a direction (e.g., Peck Peterson et al., 2005), or task completion, defined as the number of task items completed following an instruction (Reed et al., 2005). 22

42 Compliance can be measured and evaluated by (a) the length of time an individual is actively completing an assigned activity in the absence of problem behavior (duration; completion latency), (b) how many task-related responses an individual makes following an instruction (frequency; compliance rate), or (c) the length of time from an instruction to the initiation of an task-related response (latency; initiation latency) (Shriver & Allen, 1997). As a consequence-based treatment procedure for escape-maintained problem behavior, DRA Compliance procedures are typically implemented by presenting an individual with a demanding task, for example academic or vocational instructions and providing a break contingent on compliance. In a typical DRA Compliance application, problem behavior results in continued task prompts (EXT). Fixed-ratio (FR 1) schedules of reinforcement for the alternative behavior (compliance) combined with escape-ext for problem behavior has been shown to substantially reduce escapemaintained problem behavior (Reed et al., 2005; Vollmer et al., 1999; Wacker et al., 1998). Strengths of DRA Compliance. The most important aspect of a DRA procedure is its effectiveness in increasing alternative behaviors that serve the same operant function as the behavior targeted for change, oftentimes ameliorating the need for punishment contingencies (Vollmer & Iwata, 1992). DRA procedures are able to shape and establish an individual s repertoire of functionally relevant responses so that the individual has an alternative way to access reinforcement. Thus, the need for problem behavior to gain access to reinforcement can be reduced. When DRA procedures are 23

43 used for escape-maintained problem behavior, reinforcement is often provided for compliance, therefore increasing the probability of compliance under similar conditions in the future (e.g., Vollmer, Roane, Ringdahl, & Marcus, 1999). For example, Piazza et al. (1996) demonstrated an immediate decrease in the destructive behavior exhibited by an 11-year-old-boy with autism and mild mental retardation using a DRA Compliance procedure. Similarly, Reed et al. (2005) demonstrated substantial decreases in escape-maintained problem behavior and increases in compliance using a DRA Compliance intervention. Although effective in reducing problem behavior, results from both the Piazza et al. (1999) and Reed et al. (2005) studies showed bursts of problem behavior when task demands were increased over time. Although DRA Compliance procedures teach individuals an alternative response (compliance) to gain access to reinforcement, the sustained suppression of problem behavior may be negatively impacted when demands are increased over time. As demands are increased over time, the need for EXT or other programmed consequences for problem behavior becomes a critical component of the success of DRA as a consequence-based treatment option for escape-maintained problem behavior (Fisher et al., 1993). Limitations of DRA Compliance. A major limitation of DRA Compliance procedures is the appearance of initial increases in problem behavior, consistent with EXT bursts when demands are increased over time (Fisher et al., 1993). Thus, difficulties with DRA-compliance may surface when the EXT component is compromised, just as it is when EXT is used in isolation or in combination with other DR 24

44 procedures. That is, if problem behaviors are too severe or pose too great of a risk to students or teachers, the effectiveness of a DRA Compliance procedure could be negatively impacted as the demand requirements are increased over time and problem behaviors reemerge. Definition and Procedural Description of DRA Communication (FCT) DRA Communication, typically referred to as FCT (Carr & Durand, 1985) is a procedural variation of DRA Compliance where reinforcement is contingent upon an alternative communication (mand) response and reinforcement is withheld following occurrences of problem behavior. A mand is a verbal response, where the form of the response specifies its reinforcer (Skinner, 1957). For example, in the presence of a demanding work task a student mands for a break. Requesting a break (mand), for example, saying break please, when tasks are presented is a response that specifies its reinforcer. However, it should be noted that mands do not need to be vocal. FCT treatment procedures also include teaching an individual to request reinforcement by using signs, gestures, picture exchanges, and other alternative communication systems (see Carr et al., 1994 for a review of vocal and nonvocal mands taught during FCT). The idea that problem behavior may serve a communicative function has led researchers to systematically evaluate the effects of various reinforcement contingencies on the shaping and establishment of communication responses, also called mands or requests (Carr & Durand, 1985). FCT has been used successfully to reduce the occurrence of problem behaviors across populations and settings (e.g., Durand & Carr, 1987; Durand & Carr, 1991; Fisher, Kuhn, & Thompson, 1998; Shirley et al., 1997; 25

45 Shukla & Albin, 1996; Wacker et al., 1990; Worsdell, Iwata, Hanley, Thompson, & Kahng, 2000). The foundation of FCT as a treatment for escape-maintained behavior is built upon the selection of a functionally equivalent, alternative communication response that serves to replace problem (Wacker et al., 1996). A positive effect of FCT is that by increasing alternative communication responses, the motivation to engage in problem behavior can be reduced (Wacker et al., 1996). When communication increases and results in reinforcement, concomitant reductions in problem behavior have been documented (Bird, Dores, Moniz, & Robinson, 1989; Carr & Durand, 1985; Durand & Carr, 1990). Strengths of FCT. FCT has been shown to successfully and rapidly reduce problem behavior, often without initial increases in problem behavior (e.g., Durand, 1999; Derby et al., 1997). For example, Derby et al. (1997) demonstrated rapid and sustained reductions of problem behavior exhibited by 4 participants ages 2 to 5 years using FCT to teach the participants alternative communication responses to gain access to reinforcers previously identified as maintaining problem behavior. Similarly, Durand (1999) taught 5 participants to use a variety of assistive communication devices to access reinforcers previously identified to maintain problem behavior. Both studies showed immediate suppression of problem behavior with little to no bursts of problem behavior over time. Together these studies illustrate two major strengths of FCT as a treatment option for escape-maintained problem behavior: (a) rapid reductions in problem behavior, as opposed to the gradual reduction of problem behavior that is typical when EXT is used 26

46 in isolation, and (b) sustained reductions in problem behavior, with little to no reemergence of problem behavior over time. Both DRA Compliance and DRA Communication (FCT) result in teaching specific replacement behaviors for problem behavior. Teaching an individual an alternative mand may also have additional positive effects beyond that of immediate and rapid suppression in problem behavior. Once acquired, mands may produce consequences beyond the change in the targeted behavior itself, such as increased social interactions (Wacker et al., 1996). An increased repertoire of mand responses and decreased engagement in problem behavior may provide individuals with additional opportunities to access new reinforcers, for example, social interactions with peers and access reinforcers in new environments (Derby et al., 1997). For example, in addition to the rapid suppression of problem behavior demonstrated following FCT in the Derby et al. (1997) study, substantial increases in play and social behaviors were demonstrated as communication increased and problem behavior remained at low levels compared to baseline conditions. The results of this study suggest a positive side-effect of FCT may be concomitant increases in other socially acceptable behaviors as a repertoire of verbal behavior increases over time. Limitations of FCT. As a consequence-based treatment option for escapemaintained problem behavior, the efficacy of FCT may be limited if the individual requests breaks at such a high rate that the provision of reinforcement (breaks from demands) negatively impacts ongoing instructional programming (Fisher et al., 1993; Lalli & Casey, 1996; LeBlanc et al., 2002). That is, an individual may mand for breaks 27

47 from instructional tasks at such high rates that academic programming may be severely limited. Academic growth and achievement may be severely affected if individuals continue to escape instructional situations (Lalli et al., 1995; Marcus & Vollmer, 1995). Although FCT for escape-maintained problem behavior has been shown to successfully reduce problem behavior within demand contexts, the individual is still able to avoid/escape an instructional situation, albeit more appropriately; however, compliance and active engagement remains an important area to address in an effort to continue to support meaningful social and academic growth (Dube & McIlvane, 2002; LeBlanc et al., 2002). An additional limitation on the use of FCT as a consequence-based treatment option for escape-maintained problem includes the necessity of programmed consequences, such as EXT and/or punishment, for problem behavior. For example, Wacker et al. (1990) conducted a component analysis which demonstrated the necessity of consequences (EXT or punishment) for problem behavior during FCT treatments. The results showed considerable increases in problem behavior when FCT was implemented without EXT for problem behavior. In addition, substantial decreases in problem behavior and increases in communication only resulted when the FCT treatment package included differential consequences problem behavior, such as EXT. Fisher et al. (1990) and Kelley et al. (2002) found similar results supporting the need for differential consequences for problem behavior during FCT treatments designed to decrease escapemaintained problem behavior. Therefore the effectiveness of an FCT treatment program for escape-maintained problem behavior is compromised under situations where 28

48 consistent implementation of EXT may not be possible, for example within a classroom environment where a teacher s responsibilities are often too numerous to monitor and implement EXT or when the problem behavior is so severe or life threatening that EXT is not possible (Holden, 2002; Peck et al., 1996). Definition and Procedural Description of DRA Plus Demand Fading Due to the importance of increasing adaptive behaviors, such as compliance, while simultaneously decreasing problem behavior, DRA procedures have been combined with demand fading procedures. Demand fading (Piazza et al., 1996) is defined as a technique in which the number of task demands is initially limited, for example, one task demand is required, and additional demands are systematically increased over time (Piazza et al., 1996). Demand fading is also referred to in the literature as response chaining (Lalli et al., 1995), instructional fading (Ringdahl et al., 2002), and stimulus fading (Pace et al., 1994). Initial DRA-Compliance procedures might begin with a limited number of demands to establish compliance as a replacement behavior for problem behavior. A low level of demands before compliance contacts reinforcement combined with EXT for problem behavior has been shown to substantially reduce escape-maintained problem behavior (Reed et al., 2005; Vollmer et al., 1999; Wacker et al., 1998). When compliance has been achieved and problem behaviors are reduced, demands can be systematically increased so that the individual is required to complete more than one step of the task before receiving a break (negative reinforcement). 29

49 Similarly, initial FCT interventions addressing the need to increase compliance while simultaneously decreasing problem behavior, may begin by providing reinforcement following a mand only and then a mand plus increasing work requirements. For example, Lalli et al. (1995) used a response chaining procedure where participants were first required to work, and then they received a break contingent on manding for a break. The results showed reduction of problem behavior as task demands were faded into the instructional situation. Strengths of DRA plus demand fading. A major strength of DRA plus demand fading is that it is an effective technique used to slowly introduce additional demands into a DRA intervention (Zarcone et al., 1994). The gradual increase in demands creates an opportunity for individuals with escape-maintained behavior to engage in additional work beyond the initial one-step requirement traditionally associated with a DRA-Compliance procedure. Similarly, combining FCT with demand fading may attenuate the effects of increasing break requests interfering with ongoing academic instruction (LeBlanc et al., 2002). Limitations of DRA plus demand fading. Although DRA plus demand fading treatment procedures for escape-maintained problem behavior have shown to reduce problem behavior and increase compliance (e.g., Piazza et al.,1996), bursts of problem behavior may occur under increasing work requirements (e.g., Lalli et al., 1995; Zarcone et al., 1994). As the number of demands are increased and problem behavior reemerges, the need for programmed consequences, such as EXT, for problem behavior impact the utility of a DRA plus demand fading intervention package as an intervention for escape- 30

50 maintained problem behavior. Therefore the effectiveness of a DRA plus demand fading procedure may be severely affected under conditions in which EXT cannot be implemented (Pace et al., 1994; Peck et al., 1996; Peck Peterson et al., 2005; Piazza et al., 1996; Piazza et al., 1997). Specifically, if level and severity of problem behavior increases as demand requirements increase it may not be possible to safely continue instruction. Summary Research on consequence-based treatment options for problem behavior maintained by negative reinforcement have been shown to increase socially acceptable behaviors while simultaneously decreasing problem behavior. DRA and FCT treatment packages for escape-maintained problem behavior have benefits over other procedures, such as EXT and DRO, because they teach a specific replacement behavior that can then access reinforcement across a number of environments. However, the success of DRA and its procedural variation, FCT, as treatment options for escape-maintained problem behavior is affected by several variables. Specifically, when break requests are emitted at a high rate, there is a negative impact on meaningful engagement and instructional time (Lalli & Casey, 1996; LeBlanc et al., 2002). However, when task demands are increased over time before mands result in access to negative reinforcement, problem behavior may increase. These bursts of problem behavior often result in the application of EXT procedures, which have their own limitations. If EXT cannot be implemented safely because problem behaviors are too severe (Peck et al., 1996) or because of constraints on teachers time (Holden, 2002) such that problem behavior continues to contact 31

51 reinforcement, problem behavior may be maintained over time. In such cases, a concurrent schedule of reinforcement exists (Harding et al., 1999; McDowell, 1988; Peck et al., 1996; Peck Peterson et al., 2005). That is, the individual has more than one way to gain access to reinforcement, and he or she must choose which behavior to emit problem behavior or a more appropriate alternative behavior. The parameters of reinforcement associated with each choice option affect the individual s choice at any given moment (Fisher et al., 1993; Harding et al., 1999; Peck Peterson et al., 2005; Peterson et al., 1996). The interventionist s job is to identify how responding can be biased in favor of adaptive response options as opposed to maladaptive response options. Thus, it is important to understand how different parameters of reinforcement will affect choice making. Conceptual Framework for Choice Making Matching theory is the conceptual framework underlying the study of response allocation or choice among concurrently available response options (Herrnstein, 1961, 1970; McDowell, 1988; Myerson & Hale, 1984; Pierce & Epling, 1995). Matching theory describes, and in some ways allows us to predict, an individual s momentary selection of a response option relative to all other behaviors within his or her repertoire (Fisher & Mazur, 1997). Research on matching theory as it relates to choices between problem behavior and more adaptive alternatives shows that behavior is sensitive to different dimensions of reinforcement (Fisher & Mazur, 1997; Mace & Roberts, 1993; McDowell, 1988). Matching theory takes into account that behavior occurs within complex environmental contexts and that the choices individuals make between all 32

52 available response options are influenced by the reinforcer dimensions associated with each response option. When different schedules are associated with different dimensions of reinforcement, a concurrent schedule exists (Mace & Roberts, 1993). A choice occurs when an individual is confronted with a variety of alternatives and selects one alternative to the exclusion of others (McDowell, 1988, p. 96; Peterson et al., 2005). For example, in a typical DRA-Compliance intervention, when an individual is asked to engage in a demanding task, the individual can choose to engage in problem behavior or be compliant. Which response is emitted at any given moment is affected by the dimensions of reinforcement associated with each response alternative (see Mace, Neef, Shade, & Mauro, 1994, 1996; Neef & Lutz, 2001; Neef et al., 1992/ /2004/2005). Dimensions of Reinforcement The dimensions of reinforcement that can affect which behavior an individual will select at any given moment in time are: rate of reinforcement associated with each response alternative, quality of reinforcement for each response option, immediacy of reinforcement delivery following each response option, and amount or magnitude of reinforcement for each available response alternative. Rate of reinforcement refers to the schedule of reinforcement associated with each concurrently available response option and has been demonstrated as a dimension affecting response allocation (e.g., Mace et al., 1994; Neef & Lutz, 2001). Quality of reinforcement associated with different response options refers to an individual s relative preference for all concurrently available items or activities (Neef et al., 1992; Neef & 33

53 Lutz, 2001; Peck et al., 1996). For example, a variety of items or activities can be evaluated for relative preference and ranked as high, medium, and low preference when they are presented as pairs (see Fisher, Piazza, Bowman, Hagopian, Owens, & Slevin, 1992 for methods to identify a hierarchy of preference). Quality of reinforcement has also been demonstrated to affect choices between concurrently available response options, for example, choices among different sets of math problems (e.g., Neef et al., 1994). Immediacy of reinforcement delivery or delay to reinforcement refers to how quickly in time the reinforcers are delivered following a response. The delay to reinforcement following a response has also been shown to have influence over response allocation (e.g., Neef et al., 1994). Magnitude/duration (Volkert, Lerman, Vorndran, 2005) or amount (Carr, Barley, Ecott, Lucker, & Weil, 1998) often refers to how much of a reinforcer is delivered. Quantity or magnitude can be expressed in terms of quantity of time (e.g., Lerman et al., 1999), for example 30s versus 60s or in quantity/amount, for example one edible item versus five edible items. The affect of the various dimensions of reinforcement in isolation and when presented in pairs have been shown to influence the response options that are emitted at any given moment; that is, the proportion of responses on one alternative equals or matches, the proportion of reinforcements obtained from that alternative (McDowell, 1988, p. 98). When different dimensions of reinforcement are available, for example quality and duration, and an individual s behavior is sensitive to these parameters of reinforcement some researchers have suggested manipulating these dimensions within 34

54 interventions for problem behavior in an attempt to increase adaptive behavior, while simultaneously decreasing problem behavior (Mace & Roberts, 1993). Summary Matching theory provides a conceptual framework to understand choice behavior in relation to the various dimensions of reinforcement that influence response options. The separate and combined influences of different dimensions of reinforcement on response allocation, within interventions for problem behavior, have been studied within concurrent schedules arrangements. In concurrent schedules arrangements, different response options, for example problem behavior and adaptive behavior, contact different dimensions of reinforcement (Fisher & Mazur, 1997), and the influence of each dimension on response allocation are measured. Applied researchers have conceptualized interventions, such as DRA-Compliance and FCT as creating competitions between concurrently available response options, for example adaptive responses and problem behavior (Mace & Roberts, 1993). Concurrent-operants arrangements or choice making arrangements, in which more than one response alternative contacts reinforcement, have been used to assess individual s choice between response alternatives (see Cannella, O Reilly, & Lancioni, 2005; Fisher & Mazur, 1997; Peterson et al., 2005). Choice arrangements allow for the assessment of the relative influence of various dimensions of both negative and positive reinforcement on choices between response alternatives (Harding et al., 1999; Neef et al., 1994; Peck et al., 1996). Applied researchers have designed experimental arrangements using concurrent schedules arrangements to evaluate the relative influence of different dimensions of 35

55 reinforcement on the choices individuals make within interventions designed to treat problem behavior (e.g., Harding et al., 1999; Horner & Day, 1991; Peck et al., 1996; Piazza et al., 1997; Richman et al., 2001). Peck et al. (1996) suggested the goal of [a] choice-making intervention [is] to bias response allocation in the desired direction when two [or more] responses, maintained by the same reinforcer, [are] always available. Competition Between Problem Behavior and Alternative Behavior The typical reinforcement contingencies of intervention programs designed to reduce escape-maintained problem behaviors and increase socially acceptable behavior can be modified to include choice making opportunities among concurrently available reinforcers (Peck et al., 1996). The effect of the intervention can be enhanced when different parameters of reinforcement are associated with the different response options. DRA-Compliance interventions can be enhanced with choice making opportunities if different reinforcer dimensions are associated with the different response options (compliance and problem behavior). For example, if an individual s behavior is sensitive to the quality (preferred items) and amount (duration of access) of negative reinforcement, then interventions can be arranged to bias responding in favor of compliance by associating longer duration and higher quality breaks for compliance over that for problem behavior. This intervention arrangement sets up a competition between 2 concurrently available response options (problem behavior and compliance). Similarly, an FCT intervention sets up a competition between problem behavior and communication (Peck Peterson et al., 2005). Several researchers have examined the effects of response allocation within concurrent operants arrangements to better understand the impact of the 36

56 relative effects of reinforcer dimensions on problem behavior and alternative replacement behaviors within interventions for escape-maintained problem behavior (e.g., Harding et al., 1999; Horner & Day, 1991, Peck et al., 1996; Piazza et al., 1997; Richman et al., 2001). Peck et al. (1996) suggested using a concurrent schedules paradigm may eliminate the need for an EXT component during DRA interventions; therefore enhancing the effects of and addressing the limitations of differential reinforcement (DRA) interventions. In an FCT arrangement where communication and problem behavior continue to contact reinforcement, Peck et al. (1996) demonstrated that individuals choices could be biased in favor of the more adaptive response alternative over problem behavior. In this experimental arrangement communication responses were associated with higher quality and longer duration reinforcement than that which was provided for problem behavior. When problem behavior continues to contact reinforcement within DRA- Compliance procedures a concurrent schedule of reinforcement also exists. The matching theory suggests that individuals will allocate responding toward adaptive responses and away from problem behavior in relation to the parameters of reinforcement associated with each response alternative. For example, Piazza et al. (1997) showed increases in compliance and decreases in aggression for 2 of 3 participants and fewer EXT bursts during demand fading when compliance was associated with both positive and negative reinforcement and problem behavior continued to receive only negative reinforcement. Similar results were obtained by Hoch et al. (2002) and McComas, 37

57 Goddard, and Hoch (2002) without the terminal use of an EXT component for problem behavior. Similarly, when compliance and break requests continue to contact reinforcement during a DRA-Communication intervention, a concurrent schedule arrangement exists and the individual has the option to comply with task demands or request a break. Peck Peterson et al. (2005) demonstrated that choice could be biased in favor of work choices over the newly acquired communication responses previously taught during FCT when compliance resulted in access to higher quality and duration of access to reinforcement. In this study, although concurrent schedules of reinforcement were in effect for task compliance and mands, EXT was in effect for problem behavior. Collectively, the results of these studies suggest a concurrent schedules arrangement may enhance interventions designed to treat escape-maintained problem behavior while building adaptive behavior. Several of these studies (e.g., Hoch et al., 2002; Lalli et al., 1999; Peck et al., 1996; Piazza et al., 1996) suggest that the arrangement of different dimensions of reinforcement associated with the concurrently available response options may attenuate the need for an EXT component for problem behavior. To date, however, the majority of literature on response allocation within concurrent schedules of reinforcement manipulating different dimensions of reinforcement has investigated the effects on only two choice options, such as work/work options (e.g., Neef et al., 1994), work/mand options (Peck Peterson et al., 2005), work/problem behavior options (e.g., Hoch et al., 2002; Lalli et al., 1999), or mand/problem behavior options (e.g., Horner & Day, 1991). A logical extension to our 38

58 understanding of the effects competing dimensions of reinforcement within interventions designed to treat escape-maintained problem behavior would be to analyze the effects of providing competing reinforcers for 3-concurrently available response options: mands, problem behavior, and compliance. It is unknown, for example whether an individual can easily discriminate 3 concurrently-available reinforcement contingencies and whether his or her response allocation will be consistent with the dimensions of reinforcement associated with each response option. Also, it is unclear how response allocation would be affected as task demands are increased over time. Research on these questions is important for the further development of interventions for escape-motivated problem behavior. Summary of the Literature Functional analysis assessment technology provides a technique to identify the operant function of problem behaviors. Functional analysis research has identified negative reinforcement as a prevalent function maintaining problem behaviors, such as noncompliance (Derby et al., 1992; Iwata et al., 1994). Noncompliant behaviors maintained by escape from instructional demands can have a negative affect on students acquisition of new skills (Cipani & Spooner, 1997; Marcus & Vollmer, 1995). A variety of consequence-based treatment options are available to decrease escape-maintained problem behavior, while simultaneously increasing adaptive behaviors (see Iwata, 1987 for a review). Differential reinforcement treatment options, such as DRA-Compliance and FCT have advantages over other procedures such as EXT, because they are designed 39

59 to increase a repertoire of functionally-equivalent replacement behaviors to problem behaviors. The success of DRA-Compliance and its procedural variation FCT are affected by several variables that may limit their success as treatment options for escape-maintained problem behavior. DRA-Compliance procedures may be limited in their effectiveness for treatment of escape-maintained problem behavior due to the necessity of an EXT component. FCT has similar limitations in its need for an EXT component (Fisher et al., 1993; Wacker et al., 1990). FCT also has practical limitations, such as increases in the rate of break requests interfering with on-going instructional activities, thereby affecting an individual s engagement in meaningful instructional activities (Lalli et al., 1995; Marcus & Vollmer, 1995). Combining demand fading procedures with DRA-Compliance and FCT has been demonstrated to have positive effects on completion of task demands over time; however, as demands are systematically increased, problem behavior reemerges (Lalli et al., 1995; Zarcone et al., 1994). When problem behaviors increase an EXT component becomes necessary to reduce problem behavior to clinically acceptable levels. If EXT can not be implemented due to the severity of the problem behavior (Peck et al., 1996) or is impossible to implement with consistency within the constraints of a classroom environment (Holden, 2002), then problem behavior continues to contact reinforcement and may be maintained over time. This creates a concurrent schedules of reinforcement or choice making arrangement. 40

60 When concurrently available response options are associated with different dimensions of reinforcement, the applied research based on the matching theory supports the notion that the behavior that produces the most desirable reinforcement will be chosen over all other response options. To date, applied research on choice making has shown that manipulations of the reinforcer dimensions associated with 2 concurrently available response options can bias individuals choices in favor of more appropriate alternatives, such as compliance and communication. Collectively, the results of these studies suggest that the need for an EXT component can be reduced when greater qualities and durations of access to reinforcement are provided contingent on appropriate behavior over lesser quality and shorter duration for problem behavior. However, increases in problem behavior are still evident when demands are faded in over time, often creating the need for implementing EXT procedures. If EXT is not implemented as problem behavior increases within an FCT plus demand fading intervention, a 3-choice competition exists between compliance, problem, behavior, and communication. Manipulating the dimensions of reinforcement (e.g., quality and duration) associated with all 3 concurrently available response options may attenuate the need for an EXT component when demands are increased over time. However, given that little research on the effects of 3 concurrently available response options exists, or what the effects of increasing task demands within a 3-choice situation are, it is unknown whether or not this is a viable intervention option. 41

61 Research Questions 1. What are the effects of different qualities and durations of reinforcement on response allocation between problem behaviors, break choices, and work choices? Specifically, what are the effects of increasing the duration and quality of reinforcement for break choices and work choices relative to that for problem behavior? 2. Given that participants display an increase in work choices or break choices over problem behavior, what are the effects of systematically increasing work requirements on response allocation to work choices, compliance, break choices, and problem behavior? 3. What are relevant consumers perceptions about the procedures, results, and feasibility of implementing functional communication training and choice making as an intervention to increase task compliance and reduce problem behavior? 42

62 CHAPTER 3 METHOD This investigation was conducted across two phases. Phase 1: Pre-study assessments included assessments and interventions completed as part of the experimenter s position as a graduate assistant and in accordance with her responsibilities at Franklin County s Board of Mental Retardation and Developmental Disabilities (FCBMR/DD) county school programs. Collectively, the results of Phase 1 provided the information necessary for determining which participants met the inclusion criteria for Phase 2. Phase 2: Experimental Analyses was the experimental phase of the study and included the Choice Analysis, and Demand Fading analyses. Participants Students were selected for participation in Phase 2 of this study if (a) the results of Phase 1 assessments indicated at least one function of their problem behavior was to escape from task demands, (b) the results of a functional communication training (FCT) intervention indicated the participant had acquired a functional communication response (a break request), and (c) the results of the FCT indicated the break request was sensitive to changes in the quality and the duration of reinforcement provided contingent upon it. If 43

63 the participants met these criteria, Phase 2 procedures were explained to the participants parents/guardians, and the procedures were provided in writing via an informational letter and consent form (Appendix A). If their parents/guardians provided written consent for their participation, the participants were then included in Phase 2. Prior to the initiation of Phase 2, approval to conduct the investigation was obtained from FCBMR/DD s Institutional Review Board (IRB) for Human Subject Research and The Ohio State University s (OSU) IRB (see Appendix B for a copy of the letter of support and copies of the letters of permission to conduct research from FCBMR/DD and OSU IRB). The experimenter conducted an informal review of educational and medical records to obtain all labels and diagnoses used to describe the participants; therefore, all labels and diagnoses were given by sources independent of the experimenter and OSU. For the informal record review, the experimenter obtained participants files and wrote down information that pertained to the participants levels of functioning, academic programming, and any relevant medical issues (e.g., a diagnosis of a seizure disorder). See the subheading Functional Behavior Assessment (Phase 1) in Chapter 4 for additional information about the conditions under which participants displayed problem behavior (e.g., the form, the intensity, and the length of reinforcement histories). Carl Carl was an 11-year-old African American male with severe mental retardation, autism, and epilepsy. The results of a Vineland Adaptive Behavior Scale documented in Carl s educational records, indicated that he had moderate deficits in daily living skills, social, and adaptive behavior skills, as well as severe deficits in communication skills. 44

64 Carl received educational programming in an intermediate level classroom at the West Central school facility from 3 adult females (1 lead teacher and 2 instructional assistants). Carl s school activities included mealtimes (breakfast [8 a.m.] and lunch [10:15 a.m.]); independent leisure activities; a 10- to 15- min work session; special activities (e.g., art, music, physical education, speech, occupational therapy, and physical therapy); community outings; and special events (e.g., school-wide assemblies). Carl s medical records contained documentation for prescriptions of medications; however, the dosages and administrations of these medications were kept confidential by Carl s family and were not disclosed to the experimenter. Ian Ian was a 9-year-old male of biracial (African American and Caucasian) ethnic background with a diagnosis of Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS). A review of Ian s medical records revealed a diagnosis of Estropia (i.e., inward turning of the eye). Prior to the academic school year in which this study was conducted Ian received educational programming at a Midwest, urban, public elementary school in a classroom for children with multiple disabilities. Ian s educational placement changed as a result of his engagement in severe problem behavior. Ian s educational records contained reports of developmental delays, severe language deficits, and the display of challenging behaviors during transitions and work activities (specific measurement scales were not identified in Ian s records). During the academic school year in which this study took place Ian received educational programming in a primary-level classroom at FCBMR/DD s Northeast 45

65 teaching facility. Ian participated in a STACK (Structured Teaching for Autistic and Communication-delayed Kids) instructional program as described by Franklin County Educational Services Center. Ian was provided instruction on the use of a picture icon schedule and various academic and leisure activities by a one-to-one adult, female assistant and an additional 3 adult females (1 lead classroom teacher and 2 instructional aides). Ian s school activities included those identical to Carl s, with the addition of the STACK program and with the exclusion of breakfast. In addition to Ian s school programming received at Northeast, Ian also participated in a 40-hour per week homebased, intensive, behavioral intervention program. Ian s home program was supervised by a bachelor-level social worker/psychology aide trained in discrete trial programming. Ian s medical records contained documentation for prescriptions of medications; however, the dosages and administrations of these medications were kept confidential by Ian s family and were not disclosed to the experimenter. Charlie Charlie was a 13-year-old Caucasian male with mental retardation. A review of Charlie s medical records revealed diagnoses of Cornelia DeLange Syndrome, gastrointestinal reflux, and a degenerative hip condition. Charlie s educational records contained reports of delays in all areas of development as measured by DP-II Developmental profile published by Slossan Educational Publications, Inc. and an unnamed adaptive behavior scale. Charlie s behavioral intervention records indicated a 46

66 history of challenging behaviors including noncompliance (e.g., throwing task materials) during work activities. Charlie s school activities and school building were identical to Ian s; however, Charlie s educational programming was delivered in an intermediate-level classroom led by 3 adult females (1 lead teacher and 2 instructional assistants). Charlie s medical records and parent interview did not disclose any prescribed medications; however, during the study, he was given medications for gastrointestinal reflux, on a PRN basis, by the school nurse. Setting The study took place at two of FCBMR/DD s school-age teaching facilities: Northeast School, located at 500 North Hamilton Road, Gahanna, OH 43230; and West Central School, located at 1481 W. Town St., Columbus, OH FCBMR/DD school services provide educational programming for students (ranging in age from 5 21 years) who have multiple handicaps. The FCBMR/DD provides educational services in collaboration with the Franklin County school districts and its educational programming encompasses four areas of instruction: domestic, vocational, community, recreation, and leisure skills for individuals with severe disabilities. The setting for experimental sessions were private rooms (see Figures 3.1 and 3.2) located in each school building and were only used for conducting functional analyses and other experimental sessions. Carl s sessions were conducted within an enclosed 6 ft (1.82 m) x 12 ft (3.66 m) room located between two intermediate level classrooms at the West Central School; where Ian and Charlie s sessions were conducted within a 6 ft (

67 m) x 6 ft (1.82 m) room located at the back end and located away from the entrance doors of the home economics/extensions room at the Northeast School. The session rooms were equipped with a table, two chairs, video equipment (video camera and tripod), and 1 to 2, 3-drawer plastic storage bins which contained all experimental and instructional materials. Figure 3.1: Schematic of the session room used for Carl. 48

68 Figure 3.2: Schematic of the session room used for Ian and Charlie. 49

69 Experimenter The experimenter was a 3rd-year doctoral candidate enrolled in The Ohio State University s Special Education/Applied Behavior Analysis Ph.D. program. In 1999 she received her B.A. in psychology from Temple University in Philadelphia, Pennsylvania. In 2002 she received her M.Ed. in education and applied behavior analysis from Temple University. She is a certified special education teacher in the state of Ohio and a Board Certified Behavior Analyst. For the duration of this investigation the experimenter was employed on a 50% fulltime equivalent basis (FTE) as a graduate assistant and served as a specialized behavior analyst who coordinated the Buckeye Behavior Analysis Services (BBAS) services for FCBMR/DD s school programs. Her responsibilities included conducting functional behavior assessments for students identified and referred for services, developing and implementing positive behavior support recommendations based on assessment results, developing and executing training modules with FCBMR/DD staff, and providing other instructional or administrative assistance to FCBMR/DD faculty and staff. All Phase 1 assessments (functional behavior assessment and FCT) sessions were conducted under the guidelines and in accordance with her contracted responsibilities as a graduate assistant at FCBMR/DD. Data Collectors The experimenter was the primary data collector for all measures of the dependent variables and social validity surveys. Two graduate students (1st and 3rd - year doctoral students) enrolled in the Special Education Ph.D. program at The Ohio State University 50

70 served as secondary observers for interobserver agreement measures of the dependent variables. The secondary observers were asked to participate by the experimenter and were compensated by an exchange of services agreement (e.g., assistance with research or other service responsibilities). An OSU graduate, with advanced skills in Microsoft Excel spreadsheet design, assisted with all interobserver agreement (IOA) calculations. Materials A variety of experimental and instructional materials were used during this investigation. This section describes a sample of the electronic items; edible items; activities and toys; alternative communication systems; and instructional and vocational materials used during all experimental sessions. Figures in this section represent a sample of the items used during Phase 1 and Phase 2 unless otherwise specified. The letters in parentheses correspond to the location of the item (described in the narrative) as they are displayed in the figure. Electronic Equipment Session materials (see Figure 3.3) included electronic video recording equipment and electronic timing devices. A JVC Compact VHS Camcorder (Model No. GR- SXM26OU) (A); Cannon Deluxe 200 tripod (B); and Sony or Maxell 30- to 60-min VHS-C video tapes (C) were used for all session video recording. Additional electronic materials included a Good Cook battery operated Countdown Timer/Stopwatch (D) and a set of three visual and auditory display timers (E) from Learning Resources Time Tracker (Model No. LER6900). The Time Tracker timer was not used during functional analysis sessions conducted as part of Phase 1. 51

71 Figure 3.3: Photos of electronic video recording and timing equipment. 52

72 Additional electronic materials (see Figure 3.4) included an AbleNet, Inc. Big Mack Cordless Microswitch with pre-recorded break please request (A); V-Tech Phonics from A to Z! Animated interactive game board (B); Hasbro Milton Bradley Tickle Toes Musical Electronic Game (C); Fisher Price Ocean Wonders Fishbowl (D); Disney Kid Clips: Juke Box Styled Player with Beauty and the Beast soundtrack (E); Pokar Industrial LTD Electronic Creative Keyboard (F); Shelcore Toys Shakin Wacky Sounds Driver vibrating car (G); and a Fisher Price See n Say (H). Figure 3.4: Photos of additional electronic materials. 53

73 Edible Items and Other Toys Edible items (see Figure 3.5) used during all phases of the investigation included: Frito-Lays Flamin Hot Cheetos (A); generic brand, pastel colored mini-marshmallows (B); Skittles (C); generic brand, crème-filled wafer cookies (D); generic brand fruit punch (E); and water. An additional item used during Carl s sessions included a wooden musical instrument (clacker) manufactured and distributed by Melissa & Doug s Wooden Toys (F). Figure 3.5: Photos of edible items and other toys. 54

74 Alternative Communication Systems Alternative break request communication materials (see Figure 3.6) included a 6.5 cm x 7.5 cm laminated, Mayer-Johnson, Inc. Boardmaker break card picture symbol in isolation (A; Charlie) or attached to the microswitch (B; Carl and Ian). Alternative work request communication materials included a plastic cup (C; Carl); bowl (D; Ian); and a salt shaker (E; Charlie). Figure 3.6: Photos of alternative communication systems. 55

75 Instructional, Vocational, and Other Materials Lunch tray assembly and disassembly instructional materials (see Figure 3.7) included 2, 34 cm x 38 cm plastic cafeteria trays (A); plastic bowls (B), cups (C), plates (D); metal spoons (E); paper napkins (F); empty pint-sized milk containers (G); and a paper straw (H). A 2.54 cm square of Velcro (I) was attached to each of the lunch tray items. Laminated pictures, with text labels of the lunch tray items, were attached with Velcro to the cafeteria tray. Figure 3.7: Photo of lunch tray assembly instructional materials. 56

76 Vocational instructional materials (see Figure 3.8) included task items consistent with vocational programming for restaurant re-stocking employment (filling salt shakers and sugar packet containers) and general assembly (travel kits). The salt shaker assembly task included: a set of 10 plastic-based, metal-topped salt shakers (A); 3 containers of Morton brand salt (B); and 3, 18 cm x 18 cm plastic baskets (H). The sugar packet assembly task included: a set of 7, restaurant-style, plastic sugar packet holders (C); two 100 packet boxes of Sweet n Low sugar packets (D); and 1, 18 cm x 18 cm plastic basket (H). The travel kit assembly task included: a set of 4 plastic Ziploc sandwich bags (E); travel-size Scope mouthwash (F); travel-size Crest toothpaste (G); and 18 cm x 18 cm plastic baskets (H). All session and instructional materials, excluding the video equipment and video tapes, were stored among 3, Sterilite 3-drawer plastic carts with wheels. Additional experimenter-created session materials included 3 sets of 2 laminated green, red, and yellow cm X cm construction paper cards (I) (one set per participant). 57

77 Figure 3.8: Photos of vocational instructional materials used with Charlie during FCT Break Request Training and Choice Analysis sessions. Photos of tags (I) attached to Time Tracker Timer. 58

78 Definition and Measurement of Dependent Variables Three different recording systems were used to measure the 5 primary dependent variables evaluated in this study. The dependent variables and their subcategories included (a) problem behavior (overall and choice), (b) independent requests (break requests and work requests), (c) choices (break choice and work choice), (d) other break requests, and (e) compliance. See Table 3.1 for a complete listing. Dependent Variable Subcategory Participant(s) Measurement Problem Behavior Aggression Carl, Ian 10-s Partial Interval (overall & choice) Throwing All Recording (overall) Dropping Carl, Ian Mouthing Carl Event Recording Vomiting Charlie (choice) Independent Break Microswitch (break) Carl, Ian Event Recording and Work Requests & Picture Card (break) Charlie Choices Cup (work) Carl Bowl (work) Ian Salt Shaker (work) Charlie Other Break Requests Microswitch (break) Carl, Ian Frequency within 10-s partial interval recording Compliance Carl, Ian Event Recording Table 3.1: Dependent variables, their subcategories, and measurement system. 59

79 Definitions and Measurement of Overall Problem Behaviors Problem behavior was defined individually for each participant. Only challenging behaviors maintained by negative reinforcement as identified via the functional analysis (Phase 1) and presented as a problem for behavioral consultation were targeted during Phase 2 of this investigation. Aggression Aggression included hitting, biting, scratching, and head butting, each of which were individually defined and scored during the functional analysis. However, if these behaviors served the same function, they were scored collectively as aggression during FCT - Break and Work Request Training, Choice Analysis, and Demand Fading sessions. Hitting was defined as any forceful contact between a participant s open hand or closed fist to any part of another person s body. Hitting also included the participant causing any forceful contact between a toy that he was holding and another person. Biting was defined as a participant placing his opened mouth on any part of another individual s body. Scratching was defined as a participant raking his nails (i.e., the movement of fingers in an up/down/side-to-side or pinching motion) over any part of another individual s body. Head butting was defined as a participant making contact with his head to any part of another person s body. Aggression also included throwing objects (other than a ball) at another person (see definition of throwing). 60

80 Throwing Throwing was defined as a participant propelling an object through the air. Throwing objects included the participant using his hand or other part of his body to sweep materials from the surface of the table and/or from the experimenter s hands. Throwing excluded the tapping objects on a table surface, any interactions with causeeffect toys (i.e., toys that make noise or light up when pressed or touched), and touching or moving the Time Tracker timer. Dropping Dropping was defined as the participant throwing himself onto the floor and/or falling to the floor. Dropping did not include a participant leaning back in his chair and subsequently tipping the chair over. Mouthing Mouthing was defined as the participant biting, chewing, and tearing at inedible objects with his teeth for a duration greater than 3 s. Mouthing excluded the participant simply placing inedible items (e.g., cups, spoons, toys) past the plane of the lips. Vomiting Vomiting was defined as the participant expelling previously digested food items onto the work table surface or floor. Vomiting was not scored if the participant spit out food that had not been previously swallowed. Overall problem behavior was measured using a 10-s partial interval recording procedure. The experimenter created a 10-s interval tape that signaled the end of each 10-s interval. A total of 90, 10-s interval numbers were recorded on the 15-min interval 61

81 recording tape. Observers watched 15-min videotaped sessions while simultaneously listening to the 10-s interval recording tape and measured occurrences of problem behaviors. Observers recorded whether any of the operationally defined problem behaviors occurred at any time during the 10-s interval by circling a plus on the data sheet within the interval specified on the recording tape. The percentages of 10-s intervals with problem behavior were then calculated by dividing the number of intervals with problem behavior by the total number of intervals scored (see Appendix C for examples of completed data sheets). Definition and Measurement of Independent Requests Break Requests Independent break requests emitted using the microswitch alternative communication device (Carl and Ian) were defined as the participant depressing the microswitch with any part of his hand with enough force to activate the complete prerecorded message break please without physical assistance from the experimenter. Independent break requests included the participant, with or without an adult model, depressing the microswitch one time so that the complete message, break please was audible. Independent break requests excluded the participant depressing the microswitch with physical guidance from the adult (i.e., the adult placing her hand over the participant s hand and depressing the switch) and the participant depressing the microswitch multiple times so that the complete message break please was inaudible. 62

82 Independent break requests emitted using the picture symbol communication card (Charlie) were defined as the participant handing over the break communication card in the absence of physical assistance from the experimenter. Handing over the break communication card was defined as the participant extending his hand, making contact with the card, picking up the card, and placing it in the palm of the adult s hand. During the final sessions of Charlie s choice analysis (Sessions 13 18) the definition of independent break requests was extended to include Charlie pointing to and/or touching the break card. Independent break requests excluded any card exchanges that were physically prompted. Work Requests Independent work requests were defined as a participant extending a hand or finger and making contact with the work materials (e.g., cup [Carl]; bowl [Ian]; and salt shaker [Charlie]) following a cue from the experimenter (e.g., It s time to work or you can take a break. Touch the bowl if you want to work. ) and in the absence of physical assistance from the adult. Independent work requests did not include the participant throwing the work materials. Independent break and work requests were measured using an event recording procedure. Observers watched 15-min videotaped sessions and placed an x on the data sheet under the heading choice presentation and under the corresponding dependent variable (work or mand [break request]) each time the participant requested a break or requested work. See Appendix C for an example of a completed data sheet used to measure work and break requests during FCT. Total number of break and work requests 63

83 were summarized as the number of independent work requests and the number of independent break requests. Definition and Measurement of Choices Three choice options were available during various phases of the study: break, work, and problem behavior choices. A choice was defined as the participants immediate response (within 5 s) at the moment a 3-choice option (work, break, or problem behavior) was presented by the experimenter. For example, if the experimenter presented a choice statement, and the first response displayed by the participant was problem behavior (as previously defined), problem behavior choice was recorded. If the participant requested a break, break choice was recorded. If the participant touched the work materials, work choice was recorded. If none of these three behaviors occurred within 5 s of the choice statement, a no response/represent choice was recorded. Break, work, and problem behavior choices were measured using an event recording procedure and were summarized as percent of choice (work, break, or problem behavior). Observers watched 15-min videotaped sessions and used the recording procedures identical to those used for recording work and break requests, except that two more columns were added to the data sheet for problem behavior and no response (see Appendix C for an example of a completed data sheet used to measure work, break, and problem behavior choices during Phase 2). 64

84 Definition and Measurement of Other Break Requests Other break requests were defined topographically in the same manner as independent break requests. However, these requests were scored when they occurred throughout the session rather than when the experimenter made a choice statement. Other break requests were measured using a frequency within 10-s interval recording procedure. Specifically, the observers watched 15-min videotaped sessions and placed a mark on the datasheet at any time the participant requested a break (break choices plus other break requests). At the conclusion of data collection for that session, the experimenter counted the number of break choices and the number of other break requests separately. The total number of break choices (i.e., break requests following choice presentations) was then subtracted from the total number of break requests (i.e., break requests that occurred at other times during the session), yielding the number of other break requests. These data were then summarized as number of other break requests (see Appendix C for an example of a completed data sheet used to measure other break requests during the demand fading phase of the study). Definition of and Measurement of Compliance Task compliance was measured each time a task demand was made of the participant. Task demands were defined as the experimenter verbally directing the participant to complete a step of the task analysis (e.g., pick up cup ) following a participant s work choice. Task demands included verbal directions to complete a step in the task following participants compliance with a previous task step. For example, 2 65

85 occurrences of task demands were defined as when the experimenter said, pick up cup (task demand) and the participant complied by picking up the cup, then the experimenter said, put cup on (another task demand). Task demands excluded models (e.g., the experimenter providing a model of how to execute the task step) unless the model was presented simultaneously with a verbal direction (e.g., the experimenter modeled picking up the cup while simultaneously stating the verbal direction, pick up cup ). Task demands also excluded the initial work versus break choice presentation (e.g., the choice to touch materials associated with the first step of the task or press the microswitch for a break). Compliance was defined as the participant physically executing the movements consistent with the experimenter s verbal direction within 3 s of a verbal direction. For example, if the experimenter said, Pick up cup, and the participant lifted the cup off the surface of the table, compliance was recorded. Compliance was scored even if the participant completed only part of the task step. For example, if the experimenter said put bowl on, and the participant lightly touched the bowl to the cafeteria tray but did not set it down, compliance was scored because the participant attempted to complete the requested task. This scoring procedure was used to take into account that the participant might not know how to complete the requested activity. Task demands and compliance were measured using an event recording procedure. Specifically, the observers watched 15-min videotaped sessions and placed a slash mark (\) next to the step in the task analysis that corresponded with the experimenter s verbal direction. For example, if the experimenter said, pick up cup, 66

86 the observer placed a (\) in the row and corresponding column marked pick up cup on the data sheet (see Appendix C for a sample of a task analysis data sheet). The observers marked each verbal direction as it was given by the experimenter. The total number of slashes (\) was summarized as total number of task demands. For compliance, the observers watched 15-min videotaped sessions and placed a cross mark (/) (i.e., making an X ) over the previously recorded slash mark (\) - indicating direction given and direction complied with. For example, first, the experimenter said, pick up cup and the observer simultaneously placed a slash mark (\) in the row marked pick up cup on the data sheet; secondly, if the participant complied with the direction by picking up the cup the observer simultaneously placed a cross mark (/) (i.e., completing an X on the data sheet). If the participant did not comply with the direction the (\) was left uncrossed. The number of X s marked on the data sheet were then summed yielding the total number of task instructions complied with (compliance) (see Appendix C for an example of a completed data sheet illustrating the measures for task demands and compliance). Experimental Design Choice Analysis An ABA reversal design (Kazdin, 1982) was used to evaluate the effects of manipulating different qualities and durations of reinforcement on participants choices between problem behavior choices, break choices, and work choices. The A condition was Work=HQR and consisted of providing a higher quality, longer duration of break for work requests than for break requests, while problem behavior resulted in the lowest 67

87 quality and shortest duration of break (see Table 3.2 for a listing of the contingencies associated with the Choice Analysis). The B condition was Break=HQR, in which the contingencies were reversed in that, break requests received the higher quality, longer duration breaks. Data collection for the A condition began when the FCT - Work Request Training assessment showed an increase (work requests over break requests and work requests over problem behavior choices). Data collection for the A condition ended and the B condition began when the data showed an increasing trend or stability of work choices over problem behavior choices and work choices over break choices. Data collection began for the return to A condition when the data showed an increasing trend or stability of break choices over problem behavior choices and break choices over work choices. Demand Fading A concurrent schedules arrangement with systematically increased work schedule requirements was used to evaluate the effects of systematically increasing the number of task demands with compliance that were required before the participant was given access to high quality reinforcement on participants choices between problem behavior, work, and break; engagement in overall problem behavior; occurrences of other break requests, and compliance. Data collection began when the data showed an increasing trend or stability of work choices over problem behavior and break choices during the final condition of the choice analysis. See Table 3.2 for a listing of the contingencies evaluated during Demand Fading. 68

88 Break Request Training FCT Choice Analysis Demand Fading Condition Work Request Training Work = HQR Break = HQR Work = HQR plus increased demands Problem Behavior a LQ/SD 1 LQ/SD LQ/SD LQ/SD LQ/SD Work Request and Choice Praise, choice HQ/LD 3 HQ/LD 5 MQ/MD HQ/LD presentation Break Request and Choice HQ/LD 2 MQ/MD 4 MQ/MD HQ/LD MQ/MD Prompted b Break Request HQ/LD N/A N/A N/A N/A Other Break Requests N/A N/A N/A N/A MQ/MD Prompted c Work Request N/A HQ/LD N/A N/A N/A Compliance d Praise, choice HQ/LD N/A N/A HQ/LD presentation Increased task demands e No Response Prompt break Prompt work Represent Represent Represent choice request request choice choice Notes: LQ/SD 1 = No items or attention with 10 s break, HQ/LD 2 = High preference items, enthusiastic attention for 3 min, HQ/LD 3 = High preference items with enthusiastic attention for 5 min later reduced to 1 min, MQ/MD 4 = Moderately preferred items with neutral commenting for 30 s, HQ/LD 5 = High preference items, enthusiastic attention for 1 min, Prompting a = Overall and choice problem behavior, b Prompted = hand over hand guidance, faded during both FCT-Break and Work Request training, Prompted c = hand over hand guidance (delayed = 5s, or immediate [Carl only] = 1s), Compliance d = During initial sessions of WRT = number of tasks increased by 1 each choice point then access to HQ/LD, during final sessions number of task demands was = to work request (touch work materials = HQ/LD), Increased task demands e = Number of task demands increased by 1 each 15-min session (1 9 [Carl], 1 4 [Ian]). Table 3.2: Reinforcement contingencies associated with Phase 1: Pre-study assessments and Phase 2: Experimental Analyses

89 Procedures Phase 1: Pre-study Assessments Functional Behavior Assessment The functional behavior assessment consisted of (a) Functional Assessment Interview (O Neill et al., 1997) with teachers as respondents; (b) direct observations of the target behaviors in natural settings (i.e., Antecedent Behavior Consequence (ABC) assessments); (Bijou, Peterson, & Ault, 1968; Sulzer-Azaroff & Mayer, 1991); and (c) an experimental functional analysis (Iwata et al., 1982/1994). The purpose of the functional behavior assessment was to identify the maintaining contingencies for problem behavior. Functional assessment interview. The experimenter conducted a Functional Analysis Interview (O Neill et al., 1997; see Appendix D for a blank copy of the interview form) with the participants teacher or parent and gathered information about the problem behavior(s), discovered any patterns of antecedents and consequences, and obtained information regarding previously attempted interventions. The experimenter asked respondents to provide information about the problem behavior (e.g., topography, intensity, frequency); to describe conditions under which the problem behaviors were likely and unlikely to occur; and to describe the consequences that typically followed the occurrence of problem behavior. The results of this interview were used to (a) define the behavior(s) targeted for further assessments and interventions, (b) prioritize behaviors in need of further assessment and intervention, and (c) generate hypotheses regarding the function of the target behavior. 70

90 ABC assessments. The experimenter observed the participants for a minimum of 2, 30-min sessions within their classroom and school environment and documented antecedents and consequences surrounding the occurrence of targeted problem behaviors. (see Appendix D for a copy of the ABC assessment form). These ABC assessments were conducted to (a) further refine the operational definition of the target behaviors, (b) reveal any patterns of antecedents and consequences that evoked or maintained the target behaviors, and (c) document specific consequences (e.g., exact verbal statements, type of attention) that followed problem behavior within the natural setting. At the conclusion of the ABC assessments, the experimenter generated hypothesis statements about the maintaining contingencies for problem behavior. Because these assessments yielded multiple hypotheses regarding the function of problem behavior and because the environmental function was unclear, the experimenter conducted a functional analysis to confirm or rule one or more hypotheses. Preference Assessments. Preference assessments were conducted to obtain a hierarchy of preferred tangible items and activities that were then used during Phase 1 and Phase 2. Initial preference assessments were conducted before and after the functional analysis and prior to the start of FCT -Work Request Training. One of three different assessment methodologies were used to identify high, moderate, and low quality items: forced choice (Fisher et al., 1992, DeLeon & Iwata, 1996), duration of engagement (DeLeon, Iwata, Conners, & Wallace, 1999), and multiple stimulus without replacement (MSWO) (DeLeon & Iwata, 1996). Choice of assessment method depended on the 71

91 participant s skills and abilities (see Table 3.3 for a list of the method, type, and number of initial preference assessments conducted for each participant.) Preference Assessments Participant Number Method Materials Carl 5 Forced Choice Light up and vibrating musical toys (e.g., Disney Juke Box) Ian 5 Duration of Engagement MSWO Forced Choice MSWO Charlie 2 Forced Choice Edible items (e.g., hot and regular Cheetos, skittles, breakfast items, water) Other toys and games (e.g., plush lion, musical instrument [clacker], streamers, football) Edible items (e.g., a variety of gummi-type candy [gummi worms], skittles, pretzels, water, cereal) Light up and vibrating toys (e.g., vibrating car and Tickle Toes) Musical instruments (e.g., tambourine, maraca) Other toys (e.g., Legos) Light up and musical toys (e.g., keyboard, V-Tech phonics) Edibles (e.g., fruit snacks, crèmefilled wafer cookies, chex mix, goldfish) Other toys and games (e.g., a balloon, Fisher Price See n Say, oreo cookies match) Table 3.3: Method, materials, and number of initial preference assessments conducted for each participant. 72

92 Forced choice preference assessments were conducted for all 3 participants prior to the Functional Analysis and before FCT Work Request Training for Charlie only. A forced choice method was selected because it provides a hierarchy of preference by pairing each item with all other items. First, the experimenter asked the participants parents and teacher to list 6 to 10 items and activities that they believed were among the participants most highly preferred items. Those items were then presented to the participant in pairs during the forced choice preference assessment. Prior to each assessment session, the experimenter assigned numbers to the selected items and wrote all number combinations (pairs) on index cards. Prior to presenting the first presentation of item pairing in a session, the experimenter provided the participant the opportunity to sample each of the items for 30 s. For each trial, the experimenter randomly selected an index card and placed the two items (as indicated by the number combination) at least.7 m apart and.7 m in front of the participant. If the participant approached an item (e.g., reached for and/or picked up the item) within 5 s, the experimenter provided the participant with 30 s access to that item and recorded the participant s selection on the data sheet (see Appendix E for a sample of a blank forced choice data sheet). If the item presented was an edible, the participant was given a small, bite-size portion of the item and access was limited to consumption. If the participant did not approach either item within 5 s, the experimenter removed the items and represented the trial within 5 s. If the participant approached an item on the second presentation of the trial, the experimenter provided 30-s access to the 73

93 item or edible. If the participant did not approach the item during the second trial, the pair of items was returned to the pool of items, and the pair was represented later that session at a randomly selected trial. If the participant approached both items, the experimenter blocked the participant s access to the items by placing her hand over the items, and the trial was re-presented. If the participant approached both items during the second trial, the experimenter returned the items to the pool of items and represented the pair later that session at a randomly selected trial. The assessment continued until all combinations of items were presented for at least four trials. The percentage of trials an item was chosen was calculated by dividing the number of times an item was selected by the number of trials presented and multiplying by 100 for each item. Additional assessments were conducted if (a) the participant no longer showed interest in the item (e.g., did not manipulate the item when provided with access), (b) other items with similar features became available (e.g., parent or teacher provided additional information on a preferred item), or (c) the participant no longer consumed an edible item when given access to that item. Duration of engagement preference assessments were conducted with Carl prior to FCT Break Request Training because Carl s teacher reported that he could not make a choice between two items. Prior to the assessment session, the experimenter identified 6 to 10 items in the same manner as described for the forced choice assessment. First, the experimenter provided Carl with 30 s access to each item to ensure familiarity. Next, the experimenter assigned a number to each item and randomly selected (e.g., pulled numbers from lottery) the order of item presentation. For each trial, 74

94 the experimenter placed a single item on the table at least.7 m in front of the participant. The experimenter set a timer for 2 min and used a stop watch to measure the amount of time the participant maintained physical contact with the item or until the participant engaged in problem behavior (see Appendix E for a sample of a blank duration of engagement data sheet). When 2 min elapsed, the experimenter removed the item, waited 3 to 5 s, and then presented the next item. The experimenter continued to present items until each item was presented once for 2 min. Preference was determined by rank ordering the duration of engagement (most to least) for each of the items presented. The multiple stimulus without replacement (MSWO) method of assessing preference was used for Carl and Ian prior to the first FCT Work Request Training session. The decision to use this method was based on the results of previous preference assessments (e.g., Carl s preference assessments conducted using the duration of engagement method yielded inconclusive results). Before each MSWO assessment session, the experimenter identified 5 items in the same manner as described previously and assigned numbers to each of the items. If the participant did not make a selection within 30 s, the trial and session was terminated, and the experimenter recorded the remaining items as not selected. If the participant touched more than one item, the first item contacted was counted as selected. The experimenter blocked (i.e., used her hand and placed it in front of the materials) the participant from touching more than one item simultaneously. At the end of the trial, the experimenter removed the selected item from the pool of items and rotated the remaining items by taking the item at the left end of the sequence and moving it to the right end of 75

95 the sequence. The number of times an item was selected was calculated by dividing the number of times an item was selected by the number of trials during which the item was available, resulting in the percentage of trials selected (see Appendix E for a copy of a blank MSWO datasheet.) Functional Analysis. The functional analyses were conducted within a singlesubject multielement experimental design (Kazdin, 1982) to evaluate the functional relationships between experimenter-arranged environmental conditions and the participants display of problem behavior. The results of the functional analyses provided evidence the participants behavior was maintained, at least in part by negative reinforcement. Data collection for this assessment ended when differential effects, as determined by visual inspection of the vertical distance between data paths, across experimental conditions were observed. The functional analysis procedures were based on the procedures described by Iwata et al. (1982/1994). For Carl and Ian, functional analysis sessions were 5 min in duration, and for Charlie, functional analysis sessions were 10 min in duration. All functional analysis sessions were conducted in one of the two experimental session rooms. See Table 3.4 for a description of the experimental conditions and the consequences for behavior for each participant during the functional analysis. 76

96 Free Play (control) Carl (5 min) 1 Problem Behavior Continued play (ignore) Contingent Attention Contingent Tangible 3 to 5 s attention, N/A 3 to 5 s break, task 5 mild reprimand 3 removal Contingent Escape Free play (no food) Continued play (ignore) Appropriate Continued Behavior 2 play (praise) Continued play (praise) N/A Continued task prompts 8, neutral comment Continued play (praise) Ian a (5 min) Problem Behavior Continued play (ignore) 3 to 5 s attention, 5-10 s HP mild reprimand 3 3 to 5 s break, task 6 item 4 removal N/A Appropriate Behavior Continued play (praise) Continued play (praise) Charlie (10 min) Problem Behavior N/A 3 to 5 s attention, HP 4 item restricted, Continued play (praise) Continued task prompts, neutral comment mild reprimand 3 removal N/A 3 to 5 s break, task 7 N/A Continued play (ignore) Appropriate Behavior N/A Continued play (praise) N/A Continued task prompts, neutral comment Continued play (praise) Notes: (# min) 1 = Duration of functional analysis session, Appropriate Behavior 1 = appropriate toy manipulation and/or compliance, mild reprimand 3 = Don t do that! You ll break the toy or similar statement consistent with attention observed in the classroom, HP item 4 = High preference item from preference assessment (e.g., skittles, water), task 5 = vocational disassembly task consistent with Individualized Education Plan (IEP), task 6 = Bear sorting task, following directions to pick up and put in consistent with IEP goals, task 7 = vocational assembly task consistent with IEP goals, prompts 8 = 3-prompt hierarchy (verbal, model, physical guidance). Ian a = A diverted attention condition was used to test the occurrence of problem behavior in the absence of social contingencies. No consequences were delivered for problem or appropriate behavior. Table 3.4: Consequences for behavior during functional analysis conditions

97 The contingent attention condition was designed to test the hypothesis that the participants problem behaviors were maintained by access to adult attention. During this condition the participant was given 3 to 4 moderately preferred items (e.g., Tickle Toes game, V-Tech phonics, etc.). The experimenter diverted her attention during this condition by looking at a magazine or paperwork. Contingent upon problem behavior, the experimenter delivered a mild reprimand (e.g., statements or comments observed in the classroom and documented during the initial ABC assessments, such as don t throw the toys, you ll break them ). If the participant did not engage in problem behavior, he was ignored. The contingent escape condition was designed to test the hypothesis that the participants problem behaviors were maintained by negative reinforcement (escape/avoidance of task demands). The experimenter used a least-to-most prompting sequence (verbal direction, model, full physical guidance) and instructed the participant to complete a task (e.g., assemble salt shakers, sort colored bears). As long as the participant did not engage in the problem behavior, task prompts continued. Contingent upon problem behavior, the experimenter removed the task materials and turned her back for 3 to 5 s. Once 3 to 5 s had elapsed the experimenter represented the task. The contingent tangible condition was designed to test the occurrence of problem behavior under conditions in which a preferred item was within view, but access to it was restricted. During this condition the participant was given brief (3 5 s) access to a preferred toy, activity, or edible item. The experimenter then said, It s my turn, removed the item from the participant, and provided access to a moderately or low 78

98 preferred item. Contingent upon problem behavior, the experimenter provided the participant with brief access (e.g., 5 s) to the preferred item. If the participant did not display problem behavior, the preferred item remained within view, but the participant was only given access to the moderately or low preferred item. The diverted attention condition was designed to test whether or not the problem behavior occurred in the absence of social contingencies. During this condition, the participant was seated at a table with no toys or adult attention. The experimenter remained behind the video camera to ensure participants safety, but did not interact with the participant. All instances of appropriate behavior and problem behavior were ignored. Functional Communication Training Pre-FCT Task Assessment. Two Pre-FCT Task Assessment sessions were conducted with each participant prior to the first FCT Break Request Training session. The purposes of this assessment were (a) to establish that the participants were physically able to independently complete the tasks that were to be used in intervention sessions and (b) to identify the number of task steps the participants would complete, on average, before engaging in problem behavior. During task assessment sessions, the participants were presented with and instructed to complete a task (e.g., It s time to work [the common instruction delivered in the typical classroom setting]). The alternative communication systems were present during the entire 15-min session; however, the participants were neither prompted nor instructed to engage in an alternative communicative response. During this condition, completing steps of the task resulted in 79

99 neutral praise statements (e.g., good, that s working ) and the experimenter continuing to present task prompts. Problem behavior and break requests also resulted in task prompts (i.e., manual guidance was used to assist the participant in completing the task). FCT-Break Request Training. A concurrent schedules design was used to evaluate the effects of 2 concurrently available schedules of reinforcement on participants response allocation between work requests, break requests, and problem behavior. In this arrangement, each concurrently-available schedule of reinforcement was associated with a different quality and duration of access to reinforcement (break request = high quality/long duration and problem behavior = low quality/short duration). Data collection began once the functional analysis was concluded. Data collection for this assessment ended when data suggested an increasing or stable trend in break requests over problem behavior and break requests over work requests. See Table 3.2 for a description of the contingencies manipulated during FCT Break Request Training. Two to 3 15-min sessions were conducted per day during FCT-Break Request Training. In this condition, both break requests and problem behavior produced a break from task demands within a concurrent schedules arrangement. However completion of task steps resulted in the continued presentation of task demands. During break request training, break requests produced a greater duration and quality of reinforcement, where problem behavior resulted in shorter duration and lesser quality reinforcement. Table 3.2 and 3.5 more specifically illustrates the contingencies applied during FCT -Break Request Training 80

100 Participant Behavior Reinforcement Contingencies Adult Behavior Quality Duration Independent work request and compliance N/A N/A Provided a neutral statement (e.g. that s working ) and represented the work/break choice Independent and prompted break requests High Quality (HQ) High preference items and praise Long Duration (LD) 3 min Provided a praise statement or similar positive attention, presented high preference tangible items, set the timer or equivalent (e.g., stopwatch) with the yellow tag for 3 min Problem behavior Low quality (LQ) No items Short duration (SD) 10 s Removed task materials, presented a timer with a red tag for 10 s, and provided no attention or tangible items No response within 5 s N/A N/A Provided a model, a gesture, or physical guidance (e.g., hand-over-hand help) to teach the participant how to request a break using the alternative communication system Table 3.5: Contingencies applied during FCT Break Request Training

101 Prior to each session, participants were engaged in various school activities. The experimenter (a) prompted the participant to check his schedule (if he participated in a STACK program); (b) walked with the participant to the session room; and (c) provided the participant with access to a moderately preferred item in an attempt to engage the participant while the experimenter s attention was diverted (i.e., starting the video camera and session timer). The session began when the experimenter pressed the record button on the video recording equipment; started the session timer (set for 15 min); and presented the first choice. Sessions concluded when the session timer signaled the end of 15 min. The experimental arrangement used during FCT-Break Request Training was as follows: (a) the participant was seated across from or next to the experimenter, (b) the timing devices and instructional materials were within arm s length of the experimenter, (c) for each choice presentation (i.e., at the start of the session and all choice presentations following the conclusion of a break), the experimenter presented the work and alternative communication device within 3 s of each other. The choice presentation materials (i.e., work materials and alternative communication device) were placed approximately 18 cm apart on the table and within arm s length and in front of the participant (see Figures 3.1 and 3.2 for a schematic of the session rooms used). The experimenter began the session by stating, It s time to work. You can work or take a break. Touch the break card if you want a break. If the participant requested a break, the experimenter immediately provided a praise statement (e.g., great you said, 82

102 break please ), presented the Time Tracker timer with yellow tag, presented highly preferred tangible items, and engaged in parallel play for 3 min. If the participant touched the work materials, the experimenter provided a neutral comment (e.g., that s working ) and represented the choice ( You can work or take a break. Touch the break card if you want a break. ), while simultaneously providing a model, gesture (pointing), or hand-over-hand prompt to request a break. Following a prompted break request the experimenter provided a praise statement, access to the highly preferred items, the timer associated with break requests (i.e., yellow tagged timer), and engaged in play for 3 min. If the participant displayed problem behavior when the experimenter presented the work/break choice the experimenter, removed the work and break materials, presented the Time Tracker timer with red tag, and turned away from the participant for 10 s. Also, if the participant engaged in problem behavior at any other time during the session (e.g., during a high quality/long duration break), the experimenter removed all materials, presented the timer with red tag, and turned away from the participant for 10 s. Following all breaks, the experimenter represented the choice ( time to work or you can take a break ) until the timer signaled the end of the session. At the conclusion of the session the experimenter said, we re finished or similar and walked with the participant back to his classroom. FCT Work Request Training. A concurrent schedule arrangement similar to the one used during FCT - Break Request Training was used during FCT -Work Request Training; however, in this arrangement, three schedules of reinforcement were 83

103 concurrently available rather than two. Specifically, work requests contacted the schedule associated with the highest quality and longest duration of reinforcement, break requests contacted a moderate quality modest duration of reinforcement, and problem behavior continued to contact the lowest quality and shortest duration reinforcement. Data collection began when consent for participation in the study were received. See Table 3.2 and 3.6 for a listing of the contingencies associated with FCT Work Request Training 84

104 Participant Behavior Reinforcement Contingencies Adult Behavior Quality Duration Independent work request and compliance a High Quality (HQ) High preference items and praise Long Duration (LD) Provided a praise statement or similar 5 min b positive attention, presented high preference tangible items, set the timer or equivalent (e.g., stopwatch) with the green tag for 5 min Independent break requests Moderate Quality (MQ) Moderate preference items and neutral comments Moderate Duration 30 s Provided a neutral statement (e.g. you chose break ), presented moderate preference tangible items, set the timer with yellow tag for 30 s Problem behavior Low quality (LQ) No items Short duration (SD) 10 s Removed task materials, presented a timer with a red tag for 10 s, and provided no attention or tangible items No response within 5 s N/A N/A Provided a model, a gesture, or physical guidance (e.g., hand-over-hand help) to teach the participant how to request work using the alternative communication system Notes: a Initially task requirements were associated with the work request response, this was reduced to 1 step only during the final sessions of FCT Work Request Training. b LD changed from 5 min to 1 min in the final conditions of FCT Work Request Training. Table 3.6: Contingencies applied during FCT Work Request Training

105 Changes in the experimental arrangement were made if levels of response allocation did not show stability during this initial arrangement. For example, changes in the response requirements for work requests before access to reinforcement and changes in the duration of reinforcement (breaks) for work requests and break requests were made until an increasing or stable trend in work requests over break requests and work requests over problem behavior was evident. The basic experimental arrangements used during the FCT Work Request Training were identical to those used during break request training except for the following: (a) work requests contacted HQR/LD reinforcement where they previously produced continued task demands, (b) break requests were no longer prompted by the experimenter, (c) work requests were prompted if the participant did not respond within 5 s, and (d) the number of task steps required before access to the HQR/LD break for work requests were increased each time a choice was presented. Specifically, following the conclusion of a HQR/LD break, the experimenter required the participants to comply with an additional step of the task (e.g., first choice presentation work request = touch cup, where the second choice presentation work request= touch cup and pick up cup, and so on). During FCT Work Request Training several adjustments were made to the basic procedure described previously because stable responding was not observed. First, an immediate work prompt was added during Carl s sessions in an attempt to block Carl from touching both the work and break materials simultaneously. Secondly, for Carl and Ian, the increased work requirements for HQR/LD break were reduced to simply 86

106 touching the work materials each time a choice was presented rather than increasing the work requirements each time a choice was presented. This adjustment was made because it was hypothesized that the increased requirements each time a choice presentation occurred increased the effort of the work request, thereby negatively impacting the acquisition of the work request. The next procedural adjustment consisted of adding five practice trials before each FCT Work Request Training session. Practice trials consisted of the experimenter presenting the choices of work/break, immediately prompting the work choice, and providing the participant with the HQR for 1 min before staring the experimental session. This adjustment was added to insure the participants were familiar with the contingencies associated with the work request. The final adjustment consisted of decreasing the duration of the break associated with work requests from 5 min to 1 min. This adjustment was made because it was hypothesized that additional training trials were needed to establish work requests and the 5-min break duration limited the number of practice trials possible during a 15-min session to only 3. By decreasing the duration of break, the number of practice trials possible during the session increased to approximately 12 to 13. Phase 2: Experimental Analyses Choice Analysis During the choice analysis sessions, the dimensions of reinforcement (i.e., duration and quality of reinforcement) were manipulated to identify whether work choices could be increased relative to break and problem behavior choices. The choice 87

107 analysis consisted of 3 conditions: Work = High Quality Reinforcement (HQR), Break = HQR, and Return to Work = HQR. During the choice analysis, 2 to 3, 15-min sessions were conducted per day with 30 min to 60 min between sessions. Prior to each choice analysis session, an informal, mini-preference assessment was conducted to identify high and moderate preference items for use during the high and moderate quality breaks. During this assessment, the experimenter placed 5 items (e.g., items assessed in previous, formal preference assessments and one new item) on the table in random order. The experimenter determined high and moderate preference by observing the participant. The high preference item was identified as the item that the participant made contact with before touching, reaching for, or pointing to any other object. The moderate preference item was identified as the item the participant touched/reached for next. All other items were considered low preference for that day and were not used during the session. Work=HQR. In this condition, break choices, work choices, and problem behavior produced a break from task demands within a concurrent schedules arrangement. During Work = HQR, work requests produced the greatest duration and quality of reinforcement, break requests resulted in moderate duration and quality of reinforcement where, problem behavior resulted in the shortest duration and least quality reinforcement. Table 3.2 and 3.7 more specifically illustrate the contingencies applied during Work = HQR. The experimental arrangement used during Work = HQR was as follows: (a) the participant was seated across from or next to the experimenter, (b) the timing devices and instructional materials were within arm s length of the experimenter, (c) for each choice 88

108 presentation (i.e., at the start of the session and all choice presentations following the conclusion of a break), the experimenter presented the work and alternative communication device within 3 s of each other. The choice presentation materials (i.e., work materials and alternative communication device) were placed approximately 18 cm apart on the table and within arm s length and in front of the participant (see Figures 3.1 and 3.2 for a schematics of the session rooms used during the Choice Analysis). The HQR and MQR tangible items were placed directly behind the choice materials. Figure 3.9 shows the arrangement of the choice materials and their associated tangible items. Figure 3.9: Arrangement of choice materials (break and work choice) and MQR & HQR. 89

109 During this condition, the work choice materials were slightly modified for Ian. Specifically, a small plastic case was attached to the bowl used as the work choice material. The small plastic case held 1 to 2 HQR tangible items. This modification was made to help Ian discriminate between the contingencies associated with the work choice and the contingencies associated with the break choice. During this condition, the experimenter began the session by stating, It s time to work. You can work or take a break. Touch the break card if you want a break. Touch the bowl if you want to work. If the participant touched the work materials the experimenter immediately provided an enthusiastic praise statement (e.g., Fantastic! You chose work! ), while simultaneously presenting the Time Tracker timer with green tag and highly preferred tangible items. The experimenter engaged in parallel play and provided positive and enthusiastic comments (e.g., Wow! You re smart ) for 1 min. If the participant requested a break, the experimenter immediately presented the Time Tracker timer with yellow tag, and presented moderately preferred tangible items, and provided neutral commenting for 30 s. Work and break choice materials were presented in a randomized fashion (left/right) to control for possible positional preference. If the participant displayed problem behavior when the experimenter presented the work/break choice the experimenter, removed the work and break materials, presented the Time Tracker timer with red tag, and turned away from the participant for 10 s. Also, if the participant engaged in problem behavior at any other time during the session (e.g., during a high quality/long duration break), the experimenter removed all materials, presented the timer with red tag, and turned away from the participant for 10 s. 90

110 Participant Behavior Reinforcement Contingencies Adult Behavior Quality Duration Independent work choice High Quality (HQ) High preference items and praise Long Duration (LD) 1 min Provided a praise statement or similar positive attention, presented high preference tangible items, set the timer or equivalent (e.g., stopwatch) with the green tag for 1 min Independent break choice Moderate Quality (MQ) Moderate preference items and neutral comments Moderate Duration (MD) 30 s Provided a neutral statement (e.g., you chose break ), presented moderate preference tangible items, set the time for 30 s Problem behavior choice Low quality (LQ) No items Short duration (SD) 10 s Removed task materials, presented a timer with a red tag for 10 s, and provided no attention or tangible items No response within 5 s N/A N/A Represented choice Table 3.7: Contingencies applied during Work = HQR

111 If the participant did not respond, the experimenter immediately represented the work/break choice. The work/break choice was repeated until the participant touched the work materials or the break materials or engaged in problem behavior. Following all breaks, the experimenter represented the choice ( time to work or you can take a break ) until the timer signaled the end of the session. At the conclusion of the session the experimenter said, We re finished or similar and walked with the participant back to his classroom. This condition remained in place until the experimenter observed an increasing trend of work choices and low, stable patterns of overall problem behavior. Break = HQR. After a stable pattern of responding was observed during the Work = HQR condition, the contingencies for work choices and break choices were reversed to demonstrate sensitivity to the differing dimensions of reinforcement. See Tables 3.2 and 3.8 for descriptions of the specific contingencies associated with Break = HQR. All other experimental arrangements were the same as Work = HQR. When stable responding in the B condition occurred, the A condition was reinstated. 92

112 Participant Behavior Reinforcement Contingencies Adult Behavior Quality Duration Independent work choice Moderate Quality (MQ) Moderate preference items and neutral comments Moderate Duration (MD) 30 s Provided a neutral statement (e.g. that s working ), presented moderate preference tangible items, set timer with yellow tag for 30 s Independent break choice High Quality (HQ) High preference items and praise Long Duration (LD) 1 min Provided a praise statement or similar positive attention, presented high preference tangible items, set the timer or equivalent (e.g., stopwatch) with the green tag for 1 min Problem behavior choice Low quality (LQ) No items Short duration (SD) 10 s Removed task materials, presented a timer with a red tag for 10 s, and provided no attention or tangible items No response within 5 s N/A N/A Represented choice Table 3.8: Contingencies associated with Break = HQR

113 Return to Work=HQR.During this condition, the experimenter delivered task prompts and provided access to reinforcement (breaks) in the same manner in which they were delivered during the first Work=HQR condition. This condition remained in place until the experimenter observed an increasing trend of compliance to task requests and low, stable patterns of overall problem behavior and low occurrences of problem behavior choices. Demand Fading Demand fading was conducted for Carl and Ian only. Demand fading was not conducted for Charlie because the school year ended, therefore the prerequisite return to Work = HQR could not be implemented. The experimental purpose of demand fading was to evaluate the effects of systematically increased work requirements on participants response allocation between work choices, break choices, and problem behavior choices. The practical reason for conducting this phase of the study was to increase the number of task demands that the participants complied with so that they could participate in educational programming more effectively. The experimental arrangements for this condition were identical to those described in the Work=HQR condition of the choice analysis except that the experimenter systematically increased the number of steps a participant was required to comply with before the participant was given access to HQR (see Tables 3.2 and 3.9 for descriptions of the specific contingencies associated with Work = HQR plus demand fading). 94

114 Participant Behavior Reinforcement Contingencies Adult Behavior Quality Duration Independent work choice plus compliance High Quality (HQ) High preference items and praise Long Duration (LD) 1 min Following compliance, provided a praise statement or similar positive attention, presented high preference tangible items, set the timer or equivalent (e.g., stopwatch) with the green tag for 1 min Independent break choice Moderate Quality (MQ) Moderate preference items and neutral comments Moderate Duration (MD) 30 s Provided a neutral statement (e.g. you chose break ), presented moderate preference items, set timer with yellow tag for 30 s Problem behavior choice Low quality (LQ) No items Short duration (SD) 10 s Removed task materials, presented a timer with a red tag for 10 s, and provided no attention or tangible items No response within 5 s N/A N/A Represented choice Table 3.9: Contingencies associated with Work = HQR plus demand fading

115 During Work = HQR plus demand fading, the experimenter began the session by stating, It s time to work. You can work or take a break. Touch the break card if you want a break. Touch the bowl if you want to work in the same manner as Work = HQR. Figure 3.10 diagrams the experimental arrangements and consequences for behavior during Work = HQR plus demand fading. Contingencies for Work =HQR with demand fading Removal of task demands contingent on compliance (FR 1 to FR 5) Choice Presentation Work Choice plus Compliance Break Choice Problem behavior 1 a 2 b 3 c 4 d 5 e Removal of task materials, green tag with timer, presentation of HQ items for LD (1 min) Removal of task materials, present yellow tag with timer, presentation of MQ items for MD (30 s) Removal of task materials, present red tag with timer, LQ (no items) for SD (10 s) Notes: 1a-5e represents the adjusting schedule of demands. The first step the task was equal to pick up the cup (or plate). The second step of the task was equal to pick up the cup (plate) and put the cup (plate) on. The third step of the task was equal to pick up the cup (plate), put the cup (plate) on, and touch spoon. Figure 3.10: Diagram illustrating the reinforcement contingencies associated with Work = HQR plus demand fading. 96

116 When the demand requirement was equal to the first step of the task (e.g., pick up bowl ) and if the participant chose work by touching the work materials, the experimenter immediately provided an enthusiastic praise statement and the task demand (e.g., Fantastic! Pick up bowl. ). The break request alternative communication materials remained within reach of the participant and were only removed when the participant was on a break. If the participant picked up the bowl (compliance) the experimenter removed the task materials and immediately provided enthusiastic praise (e.g., Wow! You did your work. You picked up bowl. ), while simultaneously presenting the Time Tracker timer with green tag and highly preferred tangible items. The experimenter engaged in parallel play and provided positive and enthusiastic comments (e.g., Great work! We get to play! ) for 1 min. If the participant chose work, but then requested a break, the experimenter removed the task materials presented the Time Tracker timer with yellow tag, presented moderately preferred tangible items, and provided neutral commenting (e.g., No problem. You can have a break ) for 30 s. If the participant requested a break when the experimenter presented the work/break choice, the experimenter immediately presented the Time Tracker timer with yellow tag, and presented moderately preferred tangible items, and provided neutral commenting (e.g., You asked for a break ) for 30 s. If the participant displayed problem behavior when the experimenter presented the work/break choice the experimenter, removed the work and break materials, presented the Time Tracker timer with red tag, and turned away from the participant for 10 s. Also, if the participant engaged in problem 97

117 behavior at any other time during the session (e.g., during a high quality/long duration break and during task instructions), the experimenter removed all materials, presented the timer with red tag, and turned away from the participant for 10 s. If the participant did not respond to the choice presentation, the experimenter immediately represented the work/break choice. The work/break choice was repeated until the participant touched the work materials or the break materials or engaged in problem behavior. If the participant did not respond to a task demand, the task demand was repeated. During this condition, the work requirements were systematically increased each session if the occurrences of problem behavior remained low (at or below 10% of 10-s intervals within a 15-min session). For example, during the first session only the first step of the task was required (e.g., pick up bowl ), during the second session the second step (e.g., pick up bowl and put bowl on ) of the task was required. If problem behavior was higher than 10%, the next 15 min session remained at the previous task demand requirement. Following each break (HQR/LD, MQ/MD, and LQ/SD) the required task demands were represented. Following all breaks, the experimenter represented the choice ( time to work or you can take a break ) until the timer signaled the end of the session. At the conclusion of the session the experimenter said, We re finished or similar and walked with the participant back to his classroom. 98

118 Interobserver Agreement Recruitment and Training of Secondary Observers for Interobserver Agreement (IOA) The experimenter s first recruitment attempts for secondary observers were made by asking for assistance during regularly scheduled Buckeye Behavior Analysis Service (BBAS) clinic meetings held weekly at OSU, posting advertisements on OSU Special Education Department s Internet listserv, as well as providing Special Education and School Psychology OSU faculty members with an abstract and recruitment letter (see Appendix F for a copy of this letter and a copy of the description of research). There were no responses to these initial recruitment attempts. The next recruitment attempts for secondary observers were made by the experimenter asking for assistance in data collection and agreeing to an exchange of services compensation from 2 doctoral students from OSU s Special Education Doctoral program. Two doctoral students (1st and 3rd - years) served as secondary data collectors for the entire investigation. The experimenter provided each secondary observer with a 60-min pre-datacollection training session. During the first 10 to 15 minutes of training, the experimenter read and provided written examples and non-examples for each dependent variable. During the training session, the experimenter used sample video clips from randomly selected (i.e., using a number lottery), but previously scored, functional analysis sessions to demonstrate examples and nonexamples of each participants problem behavior. During the next 15 min of training the experimenter explained the data collection system for each dependent variable (e.g., 10-s partial interval, frequency within 10-s 99

119 intervals, and event recording). The experimenter used previously-scored sample data sheets with corresponding sample videos of randomly selected sessions from the functional analysis as training data sheets (see Appendix C for sample data sheets). For the next 15 min of training, the secondary observers viewed 1 to 2 training videos (e.g., sample video clips taken from actual study sessions) and practiced scoring dependent variables in which a 10-s partial interval, frequency within 10-s interval, and event recording procedures were to be used. Initially, each dependent variable was scored during separate viewings of each video clip; however, as the secondary observers became more fluent in their data collection techniques, all dependent variables were scored simultaneously during one IOA data collection session. The secondary observers data sheets were immediately compared with the experimenter s previously scored data sheet for training agreement. Training agreement for all frequency and event recording measures were calculated during the training session by dividing the smaller total by the larger total and multiplying by 100 to yield percent agreement (Bailey & Burch, 2002; Kazdin, 1982). If necessary (i.e., the agreement score was lower than 80%) the experimenter provided feedback (e.g., verbal statements about training agreement) and reviewed definitions of dependent variables. Training agreement for all dependent measures using the 10-s partial interval recording system was calculated by counting the number of intervals in which both observers agreed on an occurrence of a target behavior divided by the sum of agreements and disagreements (intervals in which two observers did not agree on an occurrence of a target behavior) and multiplying by 100 to yield percent of occurrence agreement (Bailey 100

120 & Burch, 2002; Kazdin, 1982). If necessary (i.e., the agreement score was lower than 80%) the experimenter provided feedback (e.g., verbal statements about training agreement) and reviewed definitions of dependent variables. During the final 15 min of training, the secondary observers practiced scoring randomly selected sessions from agreement training video clips with the experimenter until agreement scores were at or above 85%. When the secondary observers demonstrated at least 85% or above agreement scores, they began to score video clips randomly selected for interobserver agreement purposes. If it appeared that agreement scores were low, as determined by a quick visual inspection of agreements versus disagreements following the scoring of an IOA video clip, the experimenter reviewed all operational definitions of the dependent variables in an attempt to recalibrate the secondary observers. Sessions with agreement scores lower than 75% were placed back into the pool of randomly selected IOA sessions yet to be scored for IOA purposes and were rescored during additional IOA scoring sessions. Procedures for Collecting and Calculating Interobserver Agreement (IOA) Data Agreement was calculated for randomly selected (i.e., using a number lottery) sessions across all experimental conditions. Agreement data were scored simultaneously, but independently by the primary and secondary observers and compared to assess IOA within the measurement systems. Agreement scores were computed using a paper and pencil agreement data sheet and calculator or within a Microsoft Excel spreadsheet designed to automatically calculate agreement scores. To check the accuracy of agreement computations, a 101

121 randomly selected number agreement scores, initially scored using the paper and pencil method, were rescored using a Microsoft Excel auto-calculation method. A percentage of each experimental condition was evaluated for agreement purposes. A total frequency calculation method (Bailey & Burch, 2002) was used to calculate IOA for dependent variables recorded using event recording and frequency within 10-s intervals measurement systems (i.e., independent work and break requests, work, break, and problem behavior choices, and other session break requests; compliance; and task demands). Percent of agreement was calculated by dividing the total number of occurrences of a dependent variable recorded by the observer with the lower score by the total number recorded by the observer with the higher score and multiplying by 100. The point-by-point agreement ratio (Kazdin, 1982) was used to calculate IOA for the 10-s partial interval data. Due to the complexity of the measurement systems, variability of responding observed during the initial assessment (low to high rates of problem behavior), as well as an attempt to control for chance agreement, calculations of agreement for measures of problem behavior were assessed using occurrence agreement, nonoccurrence agreement, and occurrence-nonoccurrence agreement. First, the data sheets were compared on an interval-by-interval basis to determine the number of agreements and disagreements. Next agreement scores were computed using each of the agreement computation methods. For occurrence agreement (Bijou et al., 1968; Bailey & Burch, 2002), an agreement was counted only when both observers marked an occurrence of a dependent 102

122 variable on the data sheet within the same interval. A disagreement was counted if either of the observers marked an occurrence within an interval and the other observer did not. Any intervals in which the observers agreed that the behavior did not occur were not included in the agreement calculation. The total number of agreements were divided by the total number of agreements plus the total number of disagreements and multiplied by 100 ([AO/(AO+DO)] X 100) to yield the percent of occurrence agreement. For nonoccurrence agreement (Bijou et al., 1968; Hawkins & Dotson, 1975; Bailey & Burch, 2002), an agreement was counted only when neither observer recorded a specified dependent variable during an interval. A disagreement was counted if either of the observers marked an occurrence of a specified dependent variable within an interval and the other observer did not. Any intervals in which the observers agreed that the behavior did occur were not included in the agreement calculation. The total number of agreements were divided by the total number of agreements plus the total number of disagreements and multiplied by 100 ([AN/(AN+DN)] X 100) to yield the percent of nonoccurrence agreement. For occurrence-nonoccurrence agreement, an agreement was counted when both observers agreed that the behavior occurred or did not occur within the same interval. That is, each time both observers marked a dependent variable as occurring and each time they did not mark a dependent variable as occurring, an agreement was counted. A disagreement was counted if one observer marked an occurrence and the other did not. The percent of occurrence-nonoccurrence agreement was calculated by dividing the total 103

123 number of agreements by the total number of agreements plus disagreements and multiplying by 100 ([A/(A + D)] X 100. Procedural Integrity Measures The integrity of the independent variables implemented in this study was evaluated by the completion of procedural integrity checklists. A total of 39.6% of sessions from FCT-Break Request Training and Work Request Training, Choice Analysis, and Demand Fading conditions and across all participants were evaluated for integrity of independent variable implementation. The integrity checklists were created by the experimenter and included a list of specific procedural steps that the experimenter was required to implement correctly to ensure integrity of independent variable. (See Appendix G for a sample of blank procedural integrity checklists and directions for use for Phase 1 and Phase 2 of the study). Recruitment and Training of Procedural Integrity Evaluators Procedural integrity evaluators were initially recruited in the same manner as were the secondary agreement observers; however those recruitment techniques (e.g., recruitment letter to Special Education faculty at OSU) resulted in zero responses. The experimenter then recruited and trained one undergraduate special education student from OSU and one graduate student alumnus from OSU s Special Education Master s program. Two additional undergraduate students from Idaho State University s (ISU) Special Education program were recruited and trained by the experimenter s academic adviser and served as procedural integrity evaluators for 2 of 3 participants. 104

124 The 2 students from Ohio who served as integrity evaluators were trained on the use of the procedural integrity checklist during 2, 30-min training sessions. First, the evaluators read the directions for the use of the integrity checklist. Next, the experimenter reviewed the written directions for completing the integrity checklist and provided each evaluator with the definitions of the independent and dependent variables manipulated and investigated during FCT - Break Request and Work Request Training, during the Choice Analysis, and during Demand Fading. Then, the experimenter provided the evaluators with a randomly selected (i.e., numbers from a lottery) training video clip that had been previously scored by the experimenter. In the absence of the experimenter, the evaluators watched the video clip and scored the procedural integrity checklist. The evaluators then met with the experimenter and compared the experimenterscored integrity measures of the training clip with their own scores. Scoring differences were discussed, specifically clarifications on the response definition for problem behavior. Once the experimenter and evaluators had 100% agreement on the training clips, the outside evaluators viewed and scored all video clips independent of the experimenter. The evaluators provided the experimenter with completed integrity checklists and with procedural integrity scores as they were completed. For the ISU student observers, the experimenter provided a verbal description of the integrity scoring procedures and a packet of materials with the randomly selected video clips, directions for scoring, descriptions of the dependent and independent variables, and datasheets to her academic advisor, who then provided the training for the 105

125 two graduate students from ISU. Prior to watching and evaluating the first session, the experimenter s academic advisor verbally reviewed the response definitions and the data collection procedures with each student observer. Procedures for Measuring Procedural Integrity The integrity evaluators scored procedural integrity checklists while viewing either a digitized video clip embedded on a CD-ROM using a video player program (e.g., Windows Media Player or similar) on a computer or while viewing the video clip from a VHS tape on a VCR. The experimenter randomly selected (i.e., number lottery) sessions scored for procedural integrity across the total number of FCT, Choice Analysis, and Demand Fading sessions for each participant. The percent of procedural integrity for each condition was calculated by dividing the number of steps the experimenter completed correctly during a session by the total number of steps completed (see Appendix G for a sample of a complete integrity checklist). Interobserver agreement on measures of procedural integrity were conducted in the same manner as initial procedural integrity checks with the addition of a second observer completing a procedural integrity checklist for a session that had been previously evaluated. A total of 22.7% of procedural integrity measures were evaluated for reliability purposes. Social Validity Measures A number of steps were taken to obtain the opinions of relevant consumers (e.g., parent or teachers whose child was a participant; administrators; therapists; and behavior support staff from the educational setting) in an attempt to evaluate the social validity of 106

126 the intended purpose of the intervention, the effects of the intervention procedures, and the results of the study. Social validity was evaluated using two different assessment methods. First, measures of opinions related to the acceptability of the recommended intervention were obtained using an experimenter-modified version of The Treatment Acceptability Rating Form (TARF-R; Reimers & Wacker, 1988; Silvestri, 2004). The TARF-R highlighted the procedures and assessed consumers opinions on the impact of the proposed intervention (see Appendix H for a sample of a blank TARF Form). Second, social validity was measured by evaluating relevant consumers opinions (i.e., participants parents, teachers, and instructional aides; school administrators, behavior support staff, an occupational therapist, school psychologist and psychology aide) on the results of the initial functional analysis assessment and demand fading intervention (see Appendix H for a sample of a blank Social Validity of Results Rating Form). Procedures for Measuring and Calculating Intervention Acceptability First, the experimenter read a description of the assessment and intervention procedures to the treatment acceptability evaluators (see Appendix H for a copy of this description). Next, the experimenter asked the treatment acceptability evaluators to respond to a 20-question interview. The acceptability survey assessed the respondents opinions on the acceptability of the recommended intervention procedures on the following dimensions: (a) willingness to implement the suggested procedures, (b) acceptability and reasonability of the suggested procedures, (c) the seriousness of the participants behavior, (d) the fit of the intervention with their classroom or school, (e) 107

127 the affordability of the recommended procedures, (f) the effectiveness of the procedures, (g) the disadvantages of the suggested procedures, (h) the like of the procedures, and (i) the understanding of the procedures. The experimenter read each question and asked the respondents their opinion, using a rating scale of 1 through 7, where a rating of 1 indicated not at all acceptable, and a rating of 7 indicated very acceptable. At the conclusion of the interview, the experimenter thanked the respondents for their participation and responded to any questions. To summarize the results of the intervention acceptability assessment the experimenter first calculated the sum of scores from each respondent s intervention acceptability rating form and divided the sum by the number of respondents to each question. This yielded a mean score and range of scores for each question. Next, the experimenter grouped the 20 questions on the intervention acceptability rating form according to the 9 different dimensions of intervention acceptability listed above (a-i) and calculated the mean and range for each dimension. Procedures for Measuring and Calculating Social Impact of Results In an attempt to measure social impact of the results, the experimenter created before intervention and during intervention digitized video clips. The before intervention video samples were taken from randomly selected contingent escape conditions from Carl and Ian s functional analysis. Since the contingent escape sessions were 5 min in duration, the entire randomly selected session was digitized. A total of 2, 5-min before intervention video samples were digitized and used to assess the social impact of the 108

128 results. The during intervention video samples were taken from randomly selected Work=HQR plus demand fading sessions (Carl and Ian only). Since the Work = HQR plus demand fading sessions were 15-min in duration and contained several choice presentations, the experimenter created 4, 5-min digitized video segments. To insure that the video sample captured the scope of the session, the experimenter selected the starting point and created the digitized video segment for the during intervention video sample in the following ways: (1) the experimenter randomly selected 4 Work = HQR plus demand fading sessions from each participant s total number of demand fading sessions, (2) the experimenter played the first session videotape and started the video recording at the moment the first work/break choice was presented, (3) the experimenter continued to record until 5 min had elapsed, (4) the experimenter played the second session videotape and started the video recording at the moment the second work/break choice was presented until 5 min had elapsed. The steps were repeated so that the video segments included 5 min samples from the 1 st, 2 nd,3 rd and 4 th presentations that occurred during the Work=HQR plus demand fading sessions. All video clips were digitized and placed in random order on a CD-ROM so that those viewing the video were unaware as to which sessions constituted before and during intervention. The total duration of videos watched and scored was 60 min (30 min per participant). The experimenter asked individuals from the participants schools and the participants parents for consent to participate in the social validity of results assessment. (See Appendix I for sample consent form.) The video clips were played on the 109

129 experimenter s laptop computer using Windows Media Player. The respondents for this assessment watched the video clips during a group viewing (2-6 individuals) or individually. Prior to playing the video clip, the experimenter told the assessment respondents the video clip number. At the end of the viewing, the experimenter reminded the participants to rate the participants behavior for that clip number, but did not disclose any other information (e.g., whether the video portrayed a clip from the functional analysis or from the demand fading intervention). After viewing each video clip, the respondents provided their opinion on three questions (see Appendix J for a sample of a completed social validity of results survey form) using a 5-point Likert-type scale (where 1=strongly disagree and 5 = strongly agree) and placed the completed form in an envelope. To calculate the mean and range score per question an independent evaluator (i.e., the same individual who calculated agreement measures for the dependent variables) entered each respondent s scores into a table, summed the total score per question for each participant and divided the sum by the total number of respondents to each question to obtain the mean rating for each question for each participant. 110

130 CHAPTER 4 RESULTS Phase 1: Pre-Study Assessments Functional Behavior Assessment Functional Assessment Interview Table 4.1 summarizes the results of the functional analysis interviews for each participant. Interview respondents included Carl s teacher, Ian s teacher and parent, and Charlie s teacher. The topography, frequency, and history of the targeted problem behavior were identified by the respondents for each participant. At the conclusion of the interview, ABC assessment observations were conducted in the participants classrooms. 111

131 Participant Topography Frequency History Carl Hitting, pinching, biting, inappropriate laughing, throwing materials, dropping to the floor 5-7 times per day for ling durations (e.g., 60 min) increases around mealtimes 3+ years Ian Open hand slaps, Throwing materials, Dropping to the floor times per day (slaps), 5-10 drops per day 2+ years Charlie Throwing materials, crying, tantrums, dropping to the floor, vomiting 3-4 days per school week 3+ years Table 4.1: Functional analysis interview results. ABC Assessments Carl. Carl was observed during a leisure activity (snack time) and a teacherdirected work activity. During the leisure activity, Carl played with toys and did not interact with his teacher or peers. He used approximations to the sign for more when food was present. When leisure time was finished and Carl was asked to join circle, he did not comply with the direction to stand up and fell to he floor. When Carl was asked to engage in a work activity that required him to disassemble plastic tubes, he threw the work materials, laughed, and fell out of his chair. The teacher provided verbal and physical attention and brief removal of the task, by saying Don t do that. It is time to work and slowly picked up the work materials. Based on the interview with Carl s teacher and these observations, it was hypothesized that Carl s throwing and dropping served multiple social functions (escape and attention). 112

132 Ian. Ian was observed during leisure time and a teacher-directed work activity. During leisure time, Ian played briefly with toys (30 s) and then threw the toys to the floor. The teacher mildly reprimanded Ian (e.g., don t do that you will break the toys ) for throwing the toys and then she replaced the toys on the table. During this time, Ian left his seat, walked over to the teacher, who was seated between the exit of the play area and the rest of the classroom, and used his open hand to slap the teacher s upper arm. The teacher delivered a mild reprimand (e.g., don t hit me ) and used physical guidance to prompt Ian back to the table and toys. During the teacher-led work activity, Ian was directed to pick up plastic eggs from one plastic bin and to put the eggs into an egg carton. Ian did not respond to instructions and was physically prompted to complete the task. While being physically prompted, Ian slapped at the teacher and threw the task materials. The teacher delivered a mild reprimand (e.g., Stop throwing! ) and provided a brief (10 s) break from the task when she went to pick up the materials. Based on the interview with Ian s parent and teacher, it was hypothesized that Ian s throwing and slapping were maintained by both positive and negative reinforcement. Charlie. Charlie was observed during a leisure time and a work activity. During leisure time Charlie played with an electronic keyboard and did not interact with his peers or teacher. When Charlie was given a cue card and a direction to check his work schedule, he did not respond. The teacher then used physical prompting to guide Charlie to his activity schedule. Charlie resisted the teacher s prompts by pulling away from the teacher. The teacher continued to prompt Charlie to check his schedule. At this point, Charlie dropped to the floor and vomited. The teacher delivered a mild reprimand (e.g., 113

133 Charlie, don t do that ) and went to get a mop and a bucket, leaving Charlie unattended on the floor. Charlie watched the teacher mop the floor. While on the floor, Charlie threw all the materials that were in his reach. The adults in the classroom delivered mild reprimands from across the room (e.g., stop it ). No additional prompts were delivered to Charlie to check his schedule. Charlie stayed on the floor until it was time to exit the classroom for lunch. Based on the interview with Charlie s teacher it was hypothesized that Charlie s problem behavior (vomiting and throwing) was maintained by social consequences (attention and escape). Preference Assessments Table 4.2 summarizes the results of the initial preference assessments across participants. The identification of high and moderate quality items were based on the initial preference assessments conducted before the Functional Analysis, prior to the start of FCT, and during the mini-preference assessments conducted prior to each Choice Analysis session. 114

134 Participant High Preference Moderate Preference Low preference Carl Spicy Cheetos Musical instrument Stuffed lion Cereal bar (Clacker) Juice Streamers Fruit Snacks Musical top Fisher-Price Fish Bowl Disney Music Football Milk Cookies Water Music (radio) Ian Gummi worms Keyboard Maracas Skittles Vibrating Car Disney Music Mini-marshmallows Tambourine Fisher-Price Fishbowl V-Tech Phonics Cat/Dog Legos Tickle Toes V-Tech Phonics Tickle Toes Fruit Snacks Charlie Keyboard Oreo Cookie Match Phonics Train Goldfish crackers Tambourine Stuff toy See and Say Chex Mix Vibrating Car Vibrating Car Note: Italicized high preference items were used during high quality breaks. Italicized moderate preference items were used during moderate quality breaks. Table 4.2: Preference assessment results for all participants. Functional Analysis Carl. The top panel of Figure 4.1 displays the percent of 10-s intervals in which Carl displayed problem behavior across sessions during four experimental functional analysis conditions: contingent attention; free play with and without food; and contingent escape. An increasing trend in problem behavior was observed in the contingent escape condition with a mean 61% (range, 27% to 100%) while low and stable trends were observed in the free play with food (control condition) with a mean of 2% (range, 0% to 3%). High and variable levels of problem behavior occurred during the contingent 115

135 attention with a mean of 50% (range, 3% to 83%) and free play without food with a mean of 70% (range, 40% to 97%) conditions. Lower levels of problem behavior occurred during the final contingent attention, free play (control), and free play without food conditions relative to the contingent escape condition (Sessions 13 and 17). These results suggest both a positive and negative reinforcement function for Carl s problem behavior. 116

136 Carl Ian Charlie Figure 4.1: Percent of 10-s intervals with problem behavior displayed by Carl (top), Ian (middle), and Charlie (bottom) during the functional analysis. 117

137 Ian. The middle panel of Figure 4.1 displays the percent of 10-s intervals in which Ian displayed problem behavior across five experimental functional analysis conditions: free play; diverted attention; contingent tangible; contingent attention; and contingent escape. Elevated levels of problem behavior were observed in the first session across all 5 experimental conditions. High and variable levels of problem behavior occurred in the contingent escape condition (M = 17%, range 0% to 67%). Moderate levels of problem behavior occurred in the contingent attention (M = 5%, range 0% to14%). Lower levels of problem behavior occurred in the free play and diverted attention conditions. These results suggested multiple reinforcement functions for Ian s problem behavior. Charlie. The bottom panel of Figure 4.1 displays the percent of 10-s intervals in which Charlie displayed problem behavior across three experimental functional analysis conditions: free play; contingent escape; and contingent attention. Low to zero levels of problem behavior occurred during the contingent attention (M = 2%, range 0% to 3%) and free play (control) (0%) conditions. High levels of problem behavior occurred in the contingent escape condition (M = 13%, range 7% to 20%). These results suggested a negative reinforcement function for Charlie s problem behavior. 118

138 Functional Communication Training FCT Break and Work Request Training Figures 4.2 through 4.4 show the number of break and work requests and problem behavior (overall) for Carl, Ian, and Charlie respectively. The results are displayed in a line graph and correspond to the scale (0-10) on the left ordinate. Results for the percent of 10-s intervals with problem behavior are shown in the same figures and correspond to the scale (0% -100%) on the right ordinate. Sessions are displayed across the abscissa of each graph. 119

139 Figure 4.2: Number of break and work requests and percent of 10-s intervals with problem behavior (overall) during FCT- Break and Work Request Training for Carl

140 Carl. Results for Carl s FCT can be found in Figure 4.2. When break requests received the highest quality and longest duration (3 min) of access to reinforcement (break) during FCT - Break Request Training conditions, Carl s break requests were moderate and variable with a mean of 4.3 (range, 4 to 5), where work requests remained low with a mean of.7 (range, 0 to 1). Problem behavior was low ranging from 0% to 1% with a mean of.3% throughout this condition. The low level of problem behavior and high level of break requests indicated break requests served as a replacement for problem behavior, therefore Carl participated in FCT Work Request Training sessions. During the first condition of FCT Work Request Training, where work requests received the highest quality and duration of access to reinforcement, Carl displayed high, variable rates of independent break requests ranging from 9 to 10 with a mean of 8. Under these same conditions, the frequency of independent work requests showed an initial increase relative to that in FCT - Break Request Training, but remained low with a gradually, decreasing trend with a mean of 1.5 (range, 1 to 2) for the remainder of that condition. An increasing, low level trend of problem behavior was observed ranging from 3% to 10% with a mean of 7%. When an immediate work prompt was implemented, there was an immediate decrease in the frequency of independent break requests with a mean of.75 (range, 0 to 1) and in the levels of problem behavior with a mean of 1% (range, 0% to 1%) M = 1%. The initial number of independent work requests in this condition was 1, but remained at zero during all subsequent sessions. 121

141 When the number of work requests was reduced to the 1 st step of the task (i.e., work requirement = touch work materials) and the immediate work prompts continued, there was an immediate increase in the number of independent work requests with a mean of 2% (range, 1% to 2%) with a gradually increasing, variable trend over sessions. The rate of independent break requests decreased to zero during the initial sessions of this condition with an increase to a frequency of 4 requests in the final session. Levels of problem behavior remained low with a mean of 1% (range, 0% to 3%) with a slight increase in the final session of this condition. During the next condition, where the 5 s delay to work request prompt was reinstated and 5 work request practice trials preceded each session, there was a gradual increase in independent work requests with a mean of 2.8 (range, 2 to 4) and a gradual decrease in independent break requests with a mean of 3.4 (range, 2 to 5). Levels of problem behavior remained low and stable during this condition ranging from 0% to 3% with a mean of 1%. During the final FCT - Work Request Training condition, where the duration of breaks provided contingent upon independent work requests was reduced from 5 min to 1 min, there was an immediate and substantial increase in work requests (i.e., 10 within a 15-min session) and a moderate frequency of independent break requests (i.e., 3). Problem behavior remained low at 1%. The results of the FCT assessment showed that Carl had acquired break and work request responses and that these responses served as alternatives to replacement behaviors. Therefore, Carl met the criterion for participation in Phase 2: Experimental Analyses. 122

142 Figure 4.3: Number of break and work requests and percent of 10-s intervals with problem behavior (overall) during FCT- Break and Work Request Training for Ian

143 Ian. Results for Ian s FCT can be found in Figure 4.3. When break requests received the highest quality and longest duration (3 min) access to reinforcement (break), a moderate level with a gradually increasing trend in the frequency of independent break requests resulted. No work requests occurred under these conditions. Levels of problem behavior were low and stable with a mean of 2% (range, 0% to 4%) throughout this condition. The high rate of break requests and low level of problem behavior indicated break requests served as a replacement behavior for problem behavior; therefore, Ian met the inclusion criterion for FCT Work Request Training. When the assessment conditions changed, such that independent work requests contacted the high quality long duration break in FCT - Work Request Training, there was an immediate decrease with gradually decreasing variable trend in the frequency of independent work requests ranging from 1 to 3 with a mean of 1.83 and an immediate decrease with gradually increasing upward trend ranging from 0 to 4 with a mean of 1.33 in independent break requests. Problem behavior remained low with a mean of.67% (range, 0% to 2%) during this condition. When the requirement for work requests was reduced to the 1st step of the task, similar patterns of responding for break requests ranging from 0 to 3 with a mean of 1.6 and work requests with a mean of 1.4 (range, 1 to 2) with a gradually increasing stable trend for problem behavior and a gradually increasing, variable trend for work requests. When 5 work request practice trials preceded each work request training session, an immediate decrease in both independent work ranging from 0 to 1 with a mean of.5 and independent break requests with a mean of 1.5 (range, 1 to 2) with low levels of 124

144 problem behavior ranging from 0% to 2% with a mean of 1% resulted. Finally, when the duration of access to reinforcement was reduced from 5 min to 1 min during Ian s final work request training condition, there was an immediate increase in the frequency of independent work requests ranging from 3 to 6 with a mean of 5.7 with stability over the final two sessions (i.e., Sessions 22-23). Under these same conditions, there was an immediate increase with gradually decreasing, stable trend in the frequency of independent break requests with a mean of 4.3 (range, 5 to 6). During this condition, the mean for independent work requests 5.7 was greater relative to independent break requests 4.3. Problem behaviors remained low ranging from 2% to 7% with a mean of 4%, but the level was higher during this condition relative to previous conditions. Both FCT Break and Work Request Training results indicated Ian had acquired both work and break responses; therefore, Ian met inclusion criterion for Phase 2: Experimental Arrangements. Charlie. Results for Charlie s FCT can be found in Figure 4.4. Under conditions where break requests received the highest quality and longest duration (3 min) break, a high, stable level of independent break requests ranging from 5 to 8 with a mean of 6.3 resulted. During FCT Break Request Training no independent work requests or problem behavior occurred. The high level of break requests and low level of problem behavior during FCT Break Request Training indicated break requests served as a replacement behavior. Charlie s results from previous assessments (e.g., forced choice preference assessments and Pre-FCT work assessment sessions) indicated Charlie could 125

145 indicate a choice by touching one item versus all items on the table; therefore, Charlie did not participate in FCT Work Request Training and immediately participated in Phase 2: Experimental Arrangements. 126

146 Figure 4.4: Number of break and work requests and percent of 10-s intervals with problem behavior during FCT-Break and Work Request Training for Charlie

147 Phase 2: Experimental Analyses Choice Analysis Figures 4.5 through 4.7 show the percentage of choices (left ordinate, ascending scale; right ordinate, descending scale) for Carl, Ian, and Charlie s Choice Analysis. The results are presented in a stacked column display, which allows for comparisons across the contributions of each value (%) to the total (100%) across work choices (black shading), break choices (gray shading), and problem behavior choices (striped). The left ordinate is the scale (0% 100%) for the percent of 10-s intervals with problem behavior. Carl Figure 4.5 shows the results of Carl s choice analysis. During the Work = HQR condition, Carl s work choices ranged from 83% to 100% with a mean of 88%. Carl s work choices exceeded both break choices (M = 12% range, 0% to 17%) and problem behavior choices (0%). Other instances of problem behavior, occurring outside of choice presentations, remained low ranging from 0% to 2.2% with a mean of 1% and stable throughout this condition. 128

148 Work = HQR Break = HQR Work = HQR Percentage of Choices Percentage of Choices & Percentage of 10-s intervals With Problem Behavior Sessions Work (choice) Break (choice) Problem Behavior (choice) Problem behavior (overall) Figure 4.5: Percentage of work, break, and problem behavior choices and percentage of 10-s intervals with problem behavior during Carl s Choice Analysis

149 When the contingencies were reversed, such that break choices now contacted the highest quality and duration of break (reinforcement), Carl initially allocated responding in favor of the work choice (as illustrated in Session 5); however, the final sessions showed a stable trend for break choices ranging from 22% to 100% with a mean of 81% over work choices ranging from 0% to 78% with a mean of 19% and problem behavior (0%). Other instances of problem behaviors, occurring outside of choice presentations, remained low ranging from 0% to 2% with a mean of 1% and stable throughout this condition. During the final, return to Work=HQR condition, a gradually increasing, stable trend for work choices ranging from 44% to 100% with a mean of 76% and a gradually decreasing, stable trend for break choices with a mean 24% (range, 0% to 56%) was observed. Problem behavior choices did not occur. Under these conditions, during Session 15, where Carl allocated 50% of responding in favor of the work choice and 50% in favor of break choice, there was a slight elevation in the level of other problem behaviors (occurring at times other than at choice presentations), as compared to previous conditions; however, overall occurrences remained low ranging from 0% to 10 % with a mean of 2% throughout the condition. The final sessions of this condition (16-18) show similar patterns to those demonstrated in the initial Work =HQR condition. 130

150 Work = HQR Break = HQR Work = HQR Percentage of Choices Percentage of Choices & Percentage of 10-s intervals With Problem Behavior Sessions Work (choice) Break (choice) Problem Behavior (choice) Problem behavior (overall) Figure 4.6: Percentage of work, break, and problem behavior choices and percentage of 10-s intervals with problem behavior during Ian s Choice Analysis

151 Ian Figure 4.6 shows the results of Ian s choice analysis. The brackets underneath session numbers illustrate sessions in which a stimulus prompt (i.e., plastic case containing reinforcer was attached to the choice materials associated with HQR) was used. When work choices received the highest quality and longest duration break and a stimulus prompt was added, Ian s work choices ranging from 53% to 100% with a mean of 79% show a gradually increasing, stable trend was observed, which consistently exceeded both break ranging from 0% to 67% with a mean of 19% and problem behavior choices ranging from 0% to 13% with a mean of 3%. Other instances of problem behavior, occurring outside of choice presentations remained low ranging from 0% to 7% with a mean of 1% and stable throughout this condition. When the contingencies were reversed, such that the highest quality and longest duration of break was provided contingent upon break choices, Ian consistently allocated more responding in the direction of break choices ranging from 69% to 88% with a mean of 79% as compared to work choices ranging from 0% to 23% with a mean of 17% and problem behavior choices with a mean of 3% (range, 0% to 12%). In Session 11, a slight elevation in the level of problem behavior occurred; however, problem behavior occurring outside of choice presentations remained low ranging from 0% to 14% with a mean of 4% and stable throughout this condition. When Work = HQR was reinstated, there was an immediate increase in the level of work choices as compared to break and problem behavior choices. Work choices were high and variable ranging from 57% to 93% with a mean of 76%. Under these 132

152 conditions, levels of problem behavior were low and variable across sessions ranging from 0% to 10% with a mean of 5%. Patterns of choice allocation, during the return to Work = HQR condition were similar to the initial Work = HQR condition, with the exception of slightly elevated levels of other problem behavior. Charlie Figure 4.7 shows the results of Charlie s choice analysis. During the first condition, where work choices received the highest quality and longest duration break, Charlie s work choices (black shading) ranged from 83% to 100% with a mean of 88% show a gradually increasing, trend relative to a gradually, decreasing trend for break choices (gray shading). Charlie did not display any problem behavior under these conditions. When Break = HQR was instated there was an initial, but slight decrease in work choices relative to break choices, however work choices remained high and stable throughout Sessions 8 through 12. During Session 12 where Charlie s responses were allocated across all three response options (work choice = 82%; break choice = 12%; and problem behavior choice = 6%), a slight increase in problem behavior outside of choice presentations occurred (8%). All other problem behavior, during Sessions 8 through 11, was at zero. During Sessions 13 through 15, when the effort of the work choice was decreased from handing over the break card to touching the break card, variable levels of response allocation between work choices and break choices were observed. An increased level of break choices relative to work choices are illustrated in the final Break = HQR sessions (16-18); however, Charlie consistently chose work ranging from 18 to 133

153 100% with a mean of 70% over break ranging from 0% to 82% with a mean of 29% and problem behavior ranging from 0% to 6% with a mean of 1%. Overall levels of problem behavior were low ranging from 0% to 8% with a mean of 1% throughout this condition. Due to time limitations, imposed by the end of the academic school year, a return to the Work = HQR condition was not conducted with Charlie. 134

154 Work = HQR Break = HQR Decreased work response effort Percentage of Choices Percentage of Choices & Percentage of 10-s intervals With Problem Behavior Sessions Work (choice) Break (choice) Problem Behavior (choice) Problem behavior (overall) Figure 4.7: Percentage of work, break, and problem behavior choices and percentage of 10-s intervals with problem behavior during Charlie s Choice Analysis

155 Demand Fading Figures 4.8 through 4.9 show the results of the demand fading analysis for Carl and Ian respectively. The figure displays percentage of choices, percentage of 10-s intervals with problem behavior (overall), number of demands, compliant responses, and other break requests on the right ordinate. Sessions are displayed on the abscissa. The stacked columns (see Figure 4.8 legend) show the contributions of each value (%) to the total (100%) across work choices (black shading), break choices (gray shading). If problem behavior choices occurred they would have been displayed as a striped portion on the column. However, they never occurred, so no striped portions of the columns are present. The open circles illustrate the percentage of 10-s intervals in which the participant displayed problem behavior. The open squares represent the number of task demands, where the closed, gray squares represent the number of task demands that were complied with (compliance). The open diamonds show the number of break requests that occurred outside of choice presentations. The horizontal bar with numbers represents the number of task steps the participant was required to comply with before he was provided with access to HQR. Carl s (Figure 4.8) task requirements started at 1 and increased to 8, where Ian s (Figure 4.9) task requirements started at 1 and increased to

156 Number of Task Analysis Steps Required Before Access to HQR Sessions PB (choice) Break (choice) Work (choice) Demands Compliance Percentage of Choices, Percentage of 10-s intervals With Problem Behavior (overall), & Number of demands, compliant responses, and other break requests Problem behavior (overall) Other break requests Figure 4.8: Percentage of choices (work, break, and problem behavior), percentage of 10-s intervals with problem behavior (overall), number of demands, and compliant responses during Carl s Demand Fading

157 Carl Figure 4.8 shows the results of Carl s demand fading analysis, where a work choice and compliance to a predetermined number of task demands were required prior to access to HQR. When HQR was provided contingent upon a work choice plus a systematically increased number of work requirements (with the exclusion of Session 5), Carl s work choices ranged from 47% to 100% with a mean of 80% and consistently exceeded break choices ranging from 0% to 53% with a mean of 20% and problem behavior choices (0%). A low and stable trend was observed for both problem behaviors ranging from 0% to 16% with a mean of 4% and break requests ranging from 0% to 8% with a mean of 3% occurring outside of choice presentations, with a slight elevation in the level of problem behavior in Session 8 (16% of intervals). Carl s compliance increased as the number of task requirements was increased from 1 to 8. The slight overlap in data points (open and closed squares) shows Carl s compliance to task demands ranged from 11 to 87 with a mean of 43 and matched nearly all task demands that were given by the experimenter ranging from 11 to 90 with a mean of 56. Sessions 4 and 5 show Carl s response allocation between work choices and break choices near 50/50; with close to 100% overlap in number of task demands presented and the number of task demands Carl complied with as illustrated by the overlapping data points (open and closed squares). 138

158 Ian Figure 4.9 shows the results of the demand fading analysis for Ian. The data point markers and axes labels are identical to Carl s, except Ian s work requirements increased from 1 to 4 over the course of the analysis. Under these conditions, Ian chose work at a slightly higher level ranging from 50% to 80% with a mean of 60% relative to break choices which ranged from 20% to 50% with a mean of 40%. Problem behavior did not occur at choice presentations. The number of task demands given by the experimenter ranged from 16 to 27 with a mean of 22 of which Ian demonstrated compliance ranging from 5 to 20 with a mean of 12. During this analysis, Ian emitted no problem behavior and a low number of break requests ranging from 0 to 1 with a mean of 1 outside of choice presentations. Figure 4.9 shows an overlap in data paths for task demands and compliance (open and closed squares) demonstrating near 100% compliance with all instructions that were given by the experimenter. 139

159 Number of Task Analysis Steps Required Before Access to HQR PB (choice) Break (choice) Work (choice) Demands Percentage of Choices, Percentage of 10-s intervals With Problem Behavior (overall), & Number of demands, compliant responses, and other break requests Sessions Compliance Problem Behavior (overall) Other Break Requests Figure 4.9: Percentage of choices (work, break, and problem behavior), percentage of 10-s intervals with problem behavior (overall), number of demands, and compliance during Ian s Demand Fading

160 Interobserver Agreement (IOA) IOA results (means and ranges) are organized according to experimental conditions for the Functional Analysis, FCT Break and Work Request Training, Choice Analysis and Demand Fading evaluations. Results are reported for each dependent variable per participant and as total agreement. Table 4.3 displays the percent of sessions with IOA calculations across participants and experimental arrangements. Overall, IOA were collected for 32.4% of sessions (range 31% to 34% of sessions). Functional Analysis FCT Choice Analysis Demand Fading Participant Percent of Sessions Carl Ian Charlie N/A Totals Table 4.3: Percent of sessions with interobserver agreement calculations across participants and experimental conditions. 141

161 Functional Analysis IOA across all measures of problem behavior for each participant are shown in Tables 4.5 through IOA across all measures of problem behavior was 99% (range, 97% to 100%). The numbers in parentheses (all tables) indicate the number of sessions scored for IOA. Occurrence Nonoccurrence Occurrence- Nonoccurrence M (range) M (range) M (range) Experimental Condition Free play (no food) [2] N/A 100 ( ) 100 ( ) Free play (with food) [1] N/A 100 ( ) 100 ( ) Contingent Escape [2] N/A 100 ( ) 100 ( ) Contingent Attention [2] N/A 100 ( ) 100 ( ) Total [7] N/A 100 ( ) 100 ( ) Table 4.4: Percent interobserver agreement for aggression across each functional analysis condition for Carl. Occurrence Nonoccurrence Occurrence- Nonoccurrence M (range) M (range) M (range) Experimental Condition Free play (no food) [2] ( ) 100 ( ) Free play (with food) [1] N/A 100 ( ) 100 ( ) Contingent Escape [2] 95 (94 95) 90 ( ) 96 ( ) Contingent Attention [2] 100 ( ) 100 ( ) 100 ( ) Total [7] 98.3 (94 100) 97.5 ( ) 99 ( ) Table 4.5: Percent interobserver agreement for throwing across all functional analysis conditions for Carl. 142

162 Occurrence Nonoccurrence Occurrence- Nonoccurrence M (range) M (range) M (range) Experimental Condition Free play (no food) [2] 100 ( ) 100 ( ) 100 ( ) Free play (with [1] N/A 100 ( ) 100 ( ) food) Contingent Escape [2] 100 ( ) 100 ( ) 100 ( ) Contingent [2] (88 90 ( ) (93.10 Attention 93) Total [7] (88 100) 96.67) 97.5 ( ) ( ) Table 4.6: Percent interobserver agreement for mouthing across all functional analysis conditions for Carl. Occurrence Nonoccurrence Occurrence- Nonoccurrence M (range) M (range) M (range) Experimental Condition Free play (no food) [2] 100 ( ) 100 ( ) 100 ( ) Free play (with food) [1] N/A 100 ( ) 100 ( ) Contingent Escape [2] N/A 100 ( ) 100 ( ) Contingent Attention [2] N/A 100 ( ) 100 ( ) Total [7] 100 ( ) 100 ( ) 100 ( ) Table 4.7: Percent interobserver agreement for dropping across all functional analysis conditions for Carl. 143

163 Occurrence Nonoccurrence Occurrence- Nonoccurrence M (range) M (range) M (range) Experimental Condition Free Play (control) [2] N/A 100 ( ) 100 ( ) Diverted Attention [2] N/A 100 ( ) 100 ( ) Contingent Escape [2] (96 100) 98.2 ( ) Contingent [2] ( ) 100 ( ) Attention Contingent Tangible [2] ( ) 100 ( ) Total [10] 97 (80-100) 99.3 (96-100) ( ) Table 4.8: Percent interobserver agreement for throwing across all functional analysis conditions for Ian. Occurrence Nonoccurrence Occurrence- Nonoccurrence M (range) M (range) M (range) Experimental Condition Free Play (control) [2] N/A 100 ( ) 100 ( ) Diverted Attention [2] 100 ( ) 100 ( ) 100 ( ) Contingent Escape [2] 90 ( ) 97.5 (95 100) ( ) Contingent [2] N/A 100 ( ) 100 ( ) Attention Contingent [2] N/A 100 ( ) 100 ( ) Tangible Total [10] 95 (90 100) 99.5 (95 100) ( ) Table 4.9: Percent interobserver agreement for dropping across all functional analysis conditions for Ian. 144

164 Experimental Condition Free Play (control) Diverted Attention Contingent Escape Contingent Attention Contingent Tangible Occurrence Nonoccurrence Occurrence- Nonoccurrence M (range) M (range) M (range) [2] N/A 100 ( ) 100 ( ) [2] N/A 100 ( ) 100 ( ) [2] 100 ( ) 100 ( ) 100 ( ) [2] N/A 100 ( ) 100 ( ) [2] 100 ( ) 100 ( ) 100 ( ) Total [10] ( ) 100 ( ) Table 4.10: Percent interobserver agreement for aggression across all functional analysis conditions for Ian. Occurrence Nonoccurrence Occurrence- Nonoccurrence M (range) M (range) M (range) Experimental Condition Contingent [1] 100 ( ) 100 ( ) 100 ( ) Attention Contingent Escape [1] 100 ( ) 100 ( ) 100 ( ) Free Play (control) [1] N/A 100 ( ) 100 ( ) Total [3] 100 ( ) 100 ( ) 100 ( ) Table 4.11: Percent interobserver agreement for throwing across each functional analysis condition for Charlie. 145

165 FCT Break and Work Request Training IOA across all measures of problem behavior for each participant during FCT are shown in Table IOA across all measures of problem behavior was 99% (range, 98.2% to 99.7%). IOA across all measures of independent requests during FCT are shown in Table IOA across all independent requests was 99.8% (range, 88% to 100%). Carl Break Request Training Work Request Training Ian Break Request Training Work Request Training Charlie Work Request Training Break Request Training Occurrence Nonoccurrence Occurrence- Nonoccurrence Mean (Range) Mean (Range) Mean (Range) [1] N/A 100 ( ) 100 ( ) [7] 94.5 (78 100) 100 ( ) 98 (98 100) [2] 100 ( ) 100 ( ) 100 ( ) [5] 100 ( ) 100 ( ) 100 ( ) [2] N/A 100 ( ) 100 ( ) [N/A] N/A N/A N/A Total [17] 98.2 (78 100) (96 100) 99.5 (98 100) Table 4.12: Percent interobserver agreement across all measures of problem behavior during FCT for all participants. 146

166 FCT Break Request Training FCT Work Request Training Mean Range Mean Range Carl [8] [1] [7] Independent Work Requests Independent Break Requests (88 100) Ian [7] Independent Work N/A N/A 100 Requests Independent Break Requests Charlie [2] [N/A] Independent Work N/A N/A N/A N/A Requests Independent Break 100 N/A N/A Requests Total [17] (88 100) Table 4.13: IOA across all measures of independent requests for all participants during FCT. Choice Analysis IOA across all choice measures are shown in Table IOA across all choice measures was 100%. IOA across all measures of problem behavior for each participant are shown in Table IOA across all measures of problem behavior was 99% (range, 83% to 100%). 147

167 Work = HQR Break = HQR Work = HQR Mean (Range) Mean (Range) Mean (Range) Carl [6] [1] [2] [3] Work choice 100 ( ) 100 ( ) 100 ( ) Break choice 100 ( ) 100 ( ) 100 ( ) Problem N/A 100 ( ) N/A behavior choice Ian [8] [3] [2] [3] Work choice 100 ( ) 100 ( ) 100 ( ) Break choice 100 ( ) 100 ( ) 100 ( ) Problem N/A N/A N/A behavior choice Charlie [6] [2] [4] N/A Work choice 100 ( ) 100 ( ) N/A Break choice 100 ( ) 100 ( ) N/A Problem N/A N/A N/A behavior choice Totals [20] 100 ( ) 100 ( ) 100 ( ) Work choice 100 ( ) 100 ( ) 100 ( ) Break choice N/A 100 ( ) N/A Problem behavior choice N/A 100 ( ) N/A Table 4.14: Percent interobserver agreement across all choice measures for each participant during the choice analysis. 148

168 Work = HQR Break = HQR Work = HQR Mean (Range) Mean (Range) Mean (Range) Carl [6] [1] [2] [3] Occurrence 100 ( ) 100 ( ) 100 ( ) Nonoccurrence 100 ( ) 100 ( ) 100 ( ) Occurrence-nonoccurrence 100 ( ) 100 ( ) 100 ( ) Ian [8] [3] [2] [3] Occurrence 92 (83 100) 100 ( ) 95 (86 100) Nonoccurrence 100 ( ) 100 ( ) 100 ( ) Occurrence-nonoccurrence 100 ( ) 100 ( ) 100 ( ) Charlie [6] [2] [4] [N/A] Occurrence N/A 100 ( ) N/A Nonoccurrence 100 ( ) 100 ( ) N/A Occurrence-nonoccurrence 100 ( ) 100 ( ) N/A Totals [20] [6] [8] [6] Occurrence 96 (83 100) 100 ( ) 98 (86 100) Nonoccurrence 100 ( ) 100 ( ) 100 ( ) Occurrence-nonoccurrence 100 ( ) 100 ( ) 100 ( ) Table 4.15: Percent interobserver agreement across all measures of problem behavior for each participant during the choice analysis. Demand Fading IOA across problem behavior (overall) measures for each participant are shown in Table IOA across problem behavior (overall) measures was 100%. IOA across all choice measures for each participant are shown in Table IOA across all choice measures was 96% (range, 83% to 100%). IOA across all task demands, compliant responses, and other break request measures are shown in Table IOA across all task demands, compliant responses and other break request measures was 98.9% (range, 98.9% to 100%). 149

169 Demand Fading Mean (Range) Carl [2] Occurrence 100 ( ) Nonoccurrence 100 ( ) Occurrence-nonoccurrence 100 ( ) Ian [2] Occurrence 100 ( ) Nonoccurrence 100 ( ) Occurrence-nonoccurrence 100 ( ) Totals [4] Occurrence 100 ( ) Nonoccurrence 100 ( ) Occurrence-nonoccurrence 100 ( ) Table 4.16: Percent interobserver agreement across measures of problem behavior for Carl and Ian during demand fading. Demand Fading Mean (Range) Carl [2] Work choice 100 ( ) Break choice Problem behavior choice N/A Ian [2] Work choice 92 (83 100) Break choice 100 ( ) Problem behavior choice N/A Totals [4] Work choice 92 (83 100) Break choice 100 ( ) Problem behavior choice N/A Table 4.17: Percent interobserver agreement across all choice measures for each Carl and Ian during demand fading. 150

170 Demand Fading Mean (Range) Carl [2] Task Demands 100 ( ) Compliance 97.5 (95 100) Other Break Requests 100 ( ) Ian [2] Task Demands 95.5 ( Compliance 100 ( ) Other Break Requests 100 ( ) Totals [4] Task Demands 98 (95 100) Compliance 98.7 ( ) Other Break Requests 100 ( ) Table 4.18: Percent interobserver agreement across all task demand, compliance, and other break request measures for Carl and Ian during demand fading. 151

171 Procedural Integrity Measures Procedural integrity data are shown in Table Overall procedural integrity scores ranged from 80% to 100% with a mean of 99.2%. IOA for procedural integrity measures across all conditions was 100%. Numbers in brackets indicate the percent of sessions per condition scored for procedural integrity. Break Request Training FCT Choice Analysis Demand Fading Work Work =HQR Break=HQR Request Training 100% 98.2% (80 100%) 97.6% (83 100%) 100% 100% [57.1%] [31%] [40%] [53.8%] [31%] Table 4.19: Overall procedural integrity scores (means and ranges) across FCT Break and Work Request Training, Choice Analysis, and Demand Fading. Social Validity Intervention Acceptability Question by question results of the social validity questionnaire evaluating consumers opinions on the procedures investigated in this study across participants are shown in Table Table 4.21 displays the same ratings, but the ratings have been grouped according to 9 dimensions of intervention acceptability. A total of 9 consumers participated in this assessment. 152

172 Scores Question Mean Range How clear is your understanding of the suggested procedures? How acceptable do you find the strategies to be regarding your concerns about the identified learner? How willing are you to implement the suggested protocol as you heard them described? Given the learner s behavior issues, how reasonable do you find the suggested procedures? How costly will it be to implement these strategies? To what extent do you think there might be disadvantages in following the procedures suggested in this protocol? How likely are the suggested procedures to make a permanent improvement in the learner s behavior? Given the learner s problem behavior and the suggested time to implement the suggested procedures, how reasonable do you find the time requirements to be? How confident are you that the suggested procedures will be effective? Compared to other learners in the classroom, how serious are this learner s problem behaviors? How disruptive will it be to your classroom to implement the suggested procedures? How effective are these procedures likely to be for your learner? How affordable are these procedures? How much do you like the proposed procedures? How willing will others in your classroom be to help implement these procedures? To what extent are undesirable side effects likely to result from these procedures? How much discomfort is your learner likely to experience as a result of these procedures? How severe are this learner s behavior problems? How willing would you be to change your classroom routine to implement these procedures? How well will carrying out these procedures fit into your classroom routine? Table 4.20: Intervention acceptability rating scores, where 1 = not at all acceptable and 7= very acceptable across all questions and respondents. 153

173 Scores Dimension of Intervention [Question # s] Mean Range Acceptability Willingness [3, 4,15,19] Acceptable and Reasonable [2,8] Fit with classroom [11,20] Affordable [5, 13] Effectiveness [7, 9,12] Like of Intervention [14] Understanding [1] Disadvantages [6, 16, 17] Seriousness of Behavior [10, 18] Table 4.21: Intervention acceptability rating scores by dimension of intervention acceptability across all participants, where 1 = not at all acceptable and 7= very acceptable. Overall, consumers rated the intervention very acceptable. On dimensions of willingness, acceptability, fit with classroom, affordability, effectiveness, like and understanding of the intervention scores across respondents ranged from 1 to 7 with a mean score of 5.8. Overall, consumers ratings on questions relating to disadvantages on the intervention were low ranging from 1 to 6 with a mean of Consumers rated the intervention in relation to the seriousness of the participants problem behavior as very acceptable with scores ranging from 1 to 7 with a mean of Social Impact of Results Table 4.22 shows the results of the social validity survey that was given to relevant consumers. A total of 16 consumers participated in this social validity assessment. The group was comprised of those who participated in the treatment acceptability questionnaire with the addition of a FCBMR/DD occupational therapist and 154

174 the exclusion of one administrator. Recall that participants in this assessment viewed randomly selected and randomly arranged video clips and rated their opinion of the participants behavior by completing a 3-question social validity questionnaire according to a 5-point scale, where 1 = strongly disagree and 5 = strongly agree. Before Intervention During Intervention Question Mean Range Mean Range The student is appropriately engaged in academic or vocational work tasks, sitting appropriately (bottom in seat), and attending to the teacher of materials? The student is engaged in challenging behavior and not attending to the teacher or materials? The student appears to have a positive affect (e.g., smiling, laughing)? Table 4.22: Social validity survey results (means and ranges) per question across all respondents, where 1=strongly disagree and 5 = strongly agree Respondents rated the participants appropriate engagement higher with scores ranging from 2.0 to 5.0 with a mean of 4.4 for the during intervention (demand fading) video samples than for the before intervention video samples, mean 2.7 (range, 1.0 to 5.0). Respondents rated the participants inappropriate engagement lower with scores ranging from 1.0 to 4.0 with a mean of 1.7 for the during intervention (demand fading) video samples than for the before intervention video samples, mean 3.6 (range, 1.0 to 5.0). Respondents rated the participants positive affect higher with scores ranging from 155

175 1.0 to 5.0 with a mean of 3.5 for the during intervention (demand fading) video samples than for the before intervention video samples, mean 2.6 (range, 1.0 to 5.0). The overall scores were higher for positive impact of the intervention (appropriate engagement and positive affect for ratings on the during intervention video samples) than negative impact (inappropriate engagement). 156

176 CHAPTER 5 DISCUSSION Research Questions Research Question 1: What are the effects of different qualities and durations of reinforcement on response allocation between problem behaviors, break choices, and work choices? Specifically, what are the effects of increasing the duration and quality of reinforcement for break choices and work choices relative to that for problem behavior? The results of the choice analysis for two (Carl and Ian) of the 3 participants suggested that quality and duration of access to reinforcement influenced participants response allocation between work and break choices, over that for problem behavior choices. When 3-concurrently available response options were associated with 3 levels of reinforcer quality, the participants consistently allocated their responding in favor of the high quality reinforcer. The data from Carl s and Ian s choice analyses suggest a functional relationship between quality and duration of access to reinforcement and response allocation between work, break, and problem behavior choices. When work resulted in high quality reinforcement, Carl and Ian allocated their responses in favor of work. When the contingencies were changed, such that mands produced high quality reinforcement, Carl and Ian s response allocation shifted from work choices to break 157

177 choices. These data suggest that Carl and Ian s choices were sensitive to the qualities and durations of reinforcement that were provided contingent on each response alternative. These findings are consistent with previous choice studies evaluating the effects of quality and duration of access to reinforcement on 2 of the 3 response options (work, break, and problem behavior). For example, Peck Peterson et al. (2005) showed the influential effects of quality and duration of reinforcement on communication and compliance. The results of the Peck Peterson et al. study showed that participants response allocation between communication (mand for break) and compliance (task engagement) was influenced by the parameters of reinforcement (quality and duration) provided contingent on each response alternative. However, in that study, problem behavior produced extinction. The present study extends the Peck Peterson et al. study because problem behavior also produced reinforcement. It is important to note, however, that providing high quality reinforcement for compliance or mands continued to compete effectively with problem behavior when it produced lower quality reinforcement. The results of the present study extends the research on FCT and choice making by demonstrating that an extinction component may not be necessary to suppress problem behavior to clinically acceptable levels. The participants in the present study demonstrated relative preferences for negative reinforcement that also included positive reinforcement in the form of attention and tangible items as compared to negative reinforcement alone, as demonstrated by all 3 participants consistently choosing mands or work over problem behavior. The results of 157

178 the choice analyses for all 3 participants showed the powerful influence of positive plus negative reinforcement over negative reinforcement alone. These findings are consistent with the Lalli et al. (1999) study, which demonstrated increases in compliance and decreases in problem behavior when compliance produced access to negative plus positive reinforcement and problem behavior produced negative reinforcement (break) alone. Similarly, Piazza et al. (1997) demonstrated the influence of negative and positive reinforcement on problem behavior and compliance. In the Piazza et al. study, the most substantial increase in compliance and decrease in problem behavior was exhibited when compliance was associated with a 30-s break plus toys and attention and problem behavior was on extinction. The present study extends the findings of Lalli et al. (1999) by including programmed consequences for 3 concurrently available response (compliance, communication, and problem behavior) options over that of 2 response options (problem behavior and compliance). In the present study, work and break choices received a combination of positive and negative reinforcement, while problem behavior received negative reinforcement alone. The findings of the present study extend those reported by Piazza et al. (1997) by demonstrating substantial suppression of problem behavior without the use of extinction. Although the results for Carl and Ian clearly demonstrated the functional relationship between the dimensions of reinforcement and choice allocation, Charlie s results were less clear. During the initial condition of the choice analysis, when work choices produced access to high quality reinforcement and break choices resulted in 158

179 moderate quality reinforcement, Charlie s response allocation showed a gradual increase rather than stability of choice in favor of high quality reinforcement. Charlie showed little exclusive responding to the choice associated with high quality reinforcement. Charlie s persistence in choosing work, during the Break = HQR condition was different than the results obtained for Carl and Ian. One possible explanation for the differences in findings is that Charlie s behavior may not have been sensitive to the positive reinforcement components associated with breaks. The results of Charlie s functional analysis indicated that escape was the sole maintaining contingency for problem behavior. The results of Charlie s functional analysis differed from Carl and Ian s in that both Carl and Ian s functional analyses identified multiple maintaining contingencies for problem behavior. The effects of the choice analysis may have been influenced by the presence of multiple functions versus a single escape function. Because Charlie appeared to be motivated primarily by escape (as opposed to both escape and access to attention and/or tangibles), the contrast between concurrently available durations of negative reinforcement (1 min versus 30 s) may not have been substantial enough to consistently influence Charlie s response allocation toward break choices, when break choices resulted in access to high quality reinforcement. That is, greater differences in the duration of breaks associated with the mands and work may have resulted in more consistent response allocation. Conversely, the presence of highly preferred tangible items associated with break and work choices during the choice analysis may have contributed to the clearer results obtained for Carl and Ian. Because 159

180 both quality and duration were always presented together in this study, it is unclear if the effects would have been the same if either were presented in isolation. The variability in Charlie s choice analysis results during the Break = HQR condition suggested that the stimuli used as high quality items were inadequate in maintaining break choices over work choices. It is possible that the stimuli identified as high preference were simply not high preference enough to maintain consistent response allocation toward one response option (break choice). It is plausible that other stimuli, that is, stimuli that were not included in initial preference assessments, might have resulted in break choices exceeding work choices. In addition, the difference in the results of the choice analyses across participants may have been contextual and may have depended on the presence or absence of particular establishing operations that were not controlled in this study. An establishing operation is a stimulus event that momentarily increases the reinforcing effectiveness of a stimulus, object, or event (Michael, 1993). For Carl and Ian, the choice analysis results may have been dependent on the presence of an establishing operation (i.e., deprivation) altering the momentary effectiveness for the high quality edibles that were consistently chosen as high quality stimuli. Pre-session access to the edible items for Carl and Ian was more controlled than pre-session access to the tangible items used during Charlie s choice analysis. That is, Carl did not have access to the high preference stimuli (spicy Cheetos) and Ian rarely had access to high preference stimuli (e.g., mini-marshmallows) outside of session time, whereas Charlie s sessions frequently followed periods of free access to his preferred activity (keyboard). Carl and Ian s lack of access to food items prior to 160

181 experimental sessions may have created an establishing operation, that is, a state of deprivation, altering the momentary effectiveness of cheetos and marshmallows as reinforcers. However, for Charlie, pre-sessions access to items shown to be high preference, for example the keyboard, was not as controlled. Therefore, pre-session access to the keyboard may have created an abolishing operation, altering the effectiveness of the keyboard as a reinforcer. In addition, preference for the keyboard (HQR) could have been dependent on factors such as duration of access (within session) and in relation to previous exposures (pre-session access). However, without further analyses isolating each of these variables and measuring their effects on response allocation, these explanations remain speculative. Despite the differences between the results obtained for Carl and Ian and those for Charlie, it is important to note that the reinforcement contingencies in place for these adaptive responses did effectively compete with the reinforcement contingency for problem behavior across all 3 participants. Research Question 2: Given that participants display an increase in work requests or break requests over problem behavior, what are the effects of systematically increasing work requirements on response allocation to work requests, compliance, break requests, and problem behavior? Only Carl and Ian participated in this phase of the study. Charlie did not participate in this phase of the study because of time constraints imposed by the end of the school year. The results for Carl and Ian showed that high quality reinforcement for 161

182 work and moderate quality reinforcement for mands successfully competed with problem behavior even under conditions of increasing demands. This is especially notable because problem behavior continued to result in negative reinforcement (albeit low quality negative reinforcement) as the demands were increased. These data extend previous findings on demand fading, because a common finding in the demand fading literature is that problem behavior tends to reemerge intermittently as demands are increased (Piazza et al., 1996; Piazza et al., 1997). The results of the current study demonstrated that perhaps these bursts can be avoided by providing higher quality reinforcement for an alternative behavior (mands). Data from Carl s analysis showed that the number of demands within a 15-min work session could be increased from 10 demands to 90 demands within 9 sessions without sustained increases in problem behavior. Slight increases in break requests rather than increases in problem behavior were observed as demands were faded in over time. These results extend previous demand fading studies that have shown substantial increases in problem behavior as demands were faded in over time and the schedule for compliance is thinned (e.g., Piazza et al., 1996). The findings of this study indicate that a 3-choice concurrent schedules arrangement with 3 quantitatively different levels of reinforcement for problem behavior, compliance, and communication can be arranged to influence choices in favor of work under adjusting schedule requirements while simultaneously maintaining suppression of problem behavior. The reinforcement contingencies for the mand (break request) under conditions of increased demands were not isolated and evaluated using an experimental design. The 162

183 extent to which mands were the critical component responsible for the sustained suppression of problem behavior under increased work requirements can not be concluded from the present study. Previous research on demand fading has shown mixed results under conditions of increased demands within DRA compliance interventions (e.g., Piazza et al., 1996; Ringdahl et al, 2005). Therefore, additional research is necessary to better understand the role of the mand under increasing work requirements. The results of the demand fading analysis provides preliminary evidence to suggest that FCT, choice-making, and an adjusting work schedule intervention package may successfully reduce the need for an extinction component for problem behavior as demands are increased over time. Research Question 3: What are relevant consumers perceptions about the procedures, results, and feasibility of implementing functional communication training and choice making as an intervention to increase task compliance and reduce problem behavior? The Treatment Acceptability Rating Form-Revised (TARF; Reimers & Wacker, 1988) results revealed that relevant consumers believed the intervention procedure used in this study to be an acceptable strategy for increasing task compliance and reducing problem behavior. Consumers reported that they liked the intervention and that they understood the intervention. Overall, consumers believed the strategy of FCT and choice making as an intervention for problem behavior was a reasonable procedure that would be effective in reducing problem behavior and increasing compliance. 163

184 The results of the social impact survey with ratings of video samples of before and during intervention showed that relevant consumers agreed the participants were more appropriately engaged in an academic or vocational task and attending to the materials during intervention than prior to intervention. Prior to intervention, the relevant consumers disagreed with the statement that the participants were appropriately engaged in instructional tasks. Consumers felt strongly that the participants were engaged in more inappropriate behaviors in the video samples taken from before intervention than from video samples taken during intervention. These findings suggest consumers believed the intervention had a positive effect on participants appropriate behavior including the appearance of positive behaviors such as, contextual smiling and laughing. Consumers unsolicited comments on the social validity survey form included positive statements about the effect of the intervention on participants behavior. For example, after viewing a before-intervention video sample, one of Carl s teaching assistants wrote that Carl appeared disinterested in the task and that it appeared he was using his inappropriate behavior (throwing) to communicate that he did not want to work. However, after viewing his during-intervention video sample, Carl s teaching assistant wrote that Carl appeared to recognize what the timer was for, that he was no longer throwing the materials, and that he played with the materials appropriately. After viewing the during-intervention video sample, one of Ian s parents wrote Awesome clip! No [inappropriate] behaviors. I like how the reinforcement is presented to him so he knows what he will get for doing the task, suggesting the intervention had a positive effect on Ian s behavior. After viewing the during intervention video sample, Carl s 164

185 principal wrote There was some nice social interactions from the student. This is a big gain for him. He was active and engaged. These findings suggest that the results of the intervention positively impacted relevant consumers opinions about the changes in the participants behavior. Limitations and Future Research One possible extraneous variable that may limit the interpretations of the results of the study relates to the methods used to control the access of stimuli presented during choice analysis and demand fading sessions. The experimenter s monitoring of participants pre-session access to high preference stimuli used in the choice analysis and demand fading evaluation was not tightly controlled. As mentioned previously, the extent to which pre-session access to both positive reinforcement (e.g., edible items) and negative reinforcement (e.g., engagement in leisure activities versus work activities) affected response allocation within the choice analysis sessions was not specifically addressed for these participants and remains an area for future research. Another limitation in the methodology used in this study relates to the procedures used to present the choice options to the participants. The high quality tangible items were always presented next to the alternative communication devices during the choice analysis and demand fading sessions. It is possible that the mere presence of preferred tangible items within the work situation may have decreased the motivation to engage in escape-motivated problem behavior. The extent to which the low level of problem behaviors exhibited during the choice analysis was a result of the change in the aversiveness of the environment is unclear. Future research could address this question 165

186 by presenting the alternative communication materials without concurrently presenting the associated tangible items that is, presenting the choice of work versus break communication materials in the absence of the high quality items. For example future methods might use a rule statement, If you chose work you can play with X. If you chose break you can play with Y, versus having the actual item present. An investigation such as this has practical importance because it extends the experimental arrangements used in this study to environments that may be more typical. For example, when a teacher presents a choice between work or taking a break where the materials associated with the different response options may not be readily available. The demand fading analysis phase of this study was conducted in less than one month. Due to this time constraint, the study did not allow for further investigations into demand fading. The demand fading analysis did not use a research design to demonstrate the effect of the break request on problem behavior within the demand fading analysis. Therefore conclusions about whether the contingencies supporting the break request were responsible for the low level of problem behavior under increasing demand requirements or other extraneous variables is not clear. It remains for future research to manipulate the contingencies associated with the mand (e.g., remove the quality and duration components) under increasing demand requirements to better understand the impact of the mand on problem behavior. Under these conditions where contingencies for the mand are removed and if bursts of problem behavior and decreasing work choices result, the importance of establishing an alternative repertoire of (mands) to replace problem behavior before increasing work requirements could be more clearly demonstrated. On a 166

187 practical level these findings would be important in the development of interventions for individuals with escape-maintained problem behavior where an EXT component for problem behavior is not possible. The present study sought to investigate the effects of quality and duration of access to reinforcement on problem behavior maintained by negative reinforcement. The findings from the choice analysis showed that both quality and duration influenced choices between work and break over that for problem behavior. The present study combined the dimensions of quality (i.e., the presence of preferred tangible items) and duration (i.e., the provision of a break [negative reinforcement]); the separate effects of quality and duration were not addressed. An additional dimension of reinforcement (rate of reinforcement) was added in the demand fading analysis when the schedule of reinforcement was thinned for compliance as the work requirements increased. The findings of this study could have been affected by the combination and contribution of each dimension of reinforcement. It remains for future research to isolate the dimensions of reinforcement to better understand the impact of each dimension on response allocation between 3 concurrently available response options. One framework that might be especially useful in further analyses of 3-choice scenarios might be that of behavioral economics. Although it is beyond the scope and level of analysis of this paper to thoroughly describe behavioral economics, a brief synopsis is provided in an effort to elucidate how this study relates to behavioral economics. Behavioral economics is the study of allocation of behavior within a system of constraints (Bickel, Green, & Vuchinich, 1995). Hursh (1980) suggested that certain 167

188 concepts from behavioral economics theory may provide additional insight into the dynamic interaction between schedules of reinforcement, response rate, and choice. Specifically Hursh (1980) contends that, no simple, unidimensional choice rule, such as matching, can account for all choice behavior (p. 220). Whereas the matching law only allows one to predict qualitatively similar reinforcers (Tustin, 1994), Neef et al. (1992) and Green and Freed (1993) have suggested the use of a behavioral economics framework as a tool to predict choice for qualitatively different reinforcers. For example, in the present study qualitatively different reinforcers were available for 3-concurrently available response options. That is, the effects of high preference stimuli and a long duration break, moderate preference stimuli and a moderate duration break, and no stimuli and a short duration break under conditions of increasing schedule requirements were investigated in this study. Tustin (1994) suggests a behavioral economic analysis may provide additional tools to better understand the relation between reinforcers (Tustin, 1994). Within an economic analysis, relations between reinforcers are inferred from changes in the rate of reinforcement with a constant price (e.g., FR1 schedule for break request) when the price of an alternative reinforcer (e.g., the adjusting FR schedule for compliance used during the demand fading analysis) is varied (Tustin, 1994, p. 598). Future research could investigate the extent to which the dynamic interactions between variables such as the quality of reinforcers, response effort, immediacy to reinforcement, and rate of reinforcement effect response allocation under progressively increased work requirements. 168

189 Economic concepts and principles may provide additional conceptualizations and measures to better predict the conditions under which FCT is a viable treatment option for escape-maintained problem behavior. The adoption of economic principles and measures may extend the current choice making literature by including analyses of interactions between qualitatively different reinforcers and by providing a method to better understand and predict choice (response allocation) within a system of constraints (Bickel et al., 1995). It remains for future research to include concepts from behavioral economics literature to better understand the dynamic interactions of concurrently available and quantitatively different dimensions of reinforcement within interventions packages for escape-maintained problem behavior. Implications for Practice The results of the choice analysis suggest the utility of an assessment methodology that can be used to identify individuals sensitivity to quality and duration of access to reinforcement. The exclusion of the extinction component during interventions for escape-maintained problem behavior creates conditions in which different dimensions of reinforcement are associated with 3-concurrently available response options. The results suggest that extinction may not be necessary to suppress problem behaviors to clinically acceptable levels. The results of this study show that environmental arrangements can create situations in which students choose work over breaks following functional communication training and choose work over escapemotivated problem behavior. The results of this study have implications for practice in situations in which extinction may be difficult or impossible to implement and where 169

190 suppression of problem behavior is important. This study showed that teaching an alternative communication response (break request) successfully replaced problem behavior without the use of extinction. For students with escape-maintained problem behavior, an additional response alternative (break request) to gain access to reinforcement may increase the chances students have in contacting additional reinforcers within their environments (pivotal response; Koegel & Koegel, 1988). Understanding the dynamic interactions between concurrently available response options, when each response option is associated with qualitatively different levels of reinforcement, enhances our understanding of the utility of functional communication training programs as intervention options for escape-motivated problem behavior. Substantial decreases in problem behavior may increase the chances individuals have in accessing new environments and new reinforcers (Bosch & Fuqua, 2001). Rather than decreasing task demands or avoiding students who engage in escape-maintained problem behavior, building repertoires of adaptive behaviors, such as compliance and communication may facilitate additional social interactions from teachers, parents, and others within the students environment. Decreases in problem behavior may impact the chances students have in engaging in more diverse activities. Increases in positive, adaptive behaviors may maximize students access to other positive reinforcers (social interactions) which in turn may impact their social and academic growth (see Bosch & Fuqua, 2001 for a discussion of behavior cusps). Combining FCT with choice making opportunities may decrease the negative side-effects (i.e., substantial increases in breaks requests) associated with teaching 170

191 students alternative communication responses to access negative reinforcement. That is, by including higher quality and duration of access to breaks for compliance over that for break requests and problem behavior students may choose work over mands and problem behavior. Although the demand fading analysis was brief and did not use an experimental arrangement to systematically demonstrate that the independent variable manipulations were responsible for the dependent measures investigated in this study, the preliminary findings of the arrangements used in this study suggest that an extinction component within a FCT/DRA intervention can be removed while the schedule of reinforcement for compliance is thinned over time. The intervention arrangements employed in this study were fairly easy to implement; however, further demonstrations across populations, settings, and across implementers is warranted. Further evidence that the procedures can be employed with integrity were reflected in the high level of procedural integrity measures On a practical level, relevant consumers opinions suggested that an FCT plus choice-making intervention package was considered acceptable by those who would be ultimately responsible for implementing the program within a school setting as a treatment option for individuals with escape-motivated problem behavior. These findings are promising, in that teachers, parents, and other care providers appeared willing to use positive behavior support intervention strategies investigated in this study to increase adaptive behaviors while simultaneously decreasing inappropriate behaviors. 171

192 Summary and Contributions This study was conducted across two phases. Phase 1: Pre-Study Assessments consisted of initial evaluations and interventions to (a) determine the operant function of participants problem behavior and (b) teach the participants an alternative communication response to serve as a replacement behavior to problem behavior. Phase 2: Experimental Analyses examined the effects of different qualities and durations of reinforcement for problem behavior, compliance, and communication during an intervention for severe problem behaviors maintained by negative reinforcement. Following the initial choice analysis demonstrating participants sensitivity to different qualities and durations of reinforcement, a demand fading analysis was conducted and evaluated participants response allocation under conditions of increasing demand requirements. Three students with severe disabilities who engaged in escape-motivated problem behavior and exhibited limited communication skills participated in this study. All 3 participants acquired a functional alternative communication response (mand) that was shown to replace problem behavior during the initial FCT interventions conducted during Phase 1. Following FCT, a choice analysis was conducted where an ABA reversal design was used to evaluate the effects of manipulating different qualities (i.e., high, moderate, low preference items) and durations (1-min, 30-s, and 10-s breaks) of reinforcement on participants choices between problem behavior, break choices, and work choices. For two of the 3 participants the results of the choice analysis clearly showed quality and duration as influential dimensions on response allocation between problem 172

193 behavior, break and work choices. For all 3 participants the results of the choice making intervention showed positive effects of different qualities and durations of reinforcement for work and break choices over that for problem behavior. Two of the 3 participants were included in the demand fading analysis. During the demand fading analysis, a concurrent schedules arrangement was used to evaluate the effects of increased demands on problem behavior, compliance, and mands when all three response options contacted reinforcement. The contingencies manipulated during the demand fading were as follows: work = high quality/long duration breaks; mands = moderate quality/moderate duration breaks; and problem behavior = low quality/short duration breaks. The results showed that high quality reinforcement for work and moderate quality reinforcement for mands successfully competed with problem behavior under conditions of increasing demands. The social validity of the results was evaluated using two different assessment methods. Measures of intervention acceptability were collected using a treatment acceptability rating form and measures of the social impact of the intervention results were collected using a social validity survey. The combined results of these measures indicated relevant consumers found the intervention acceptable and the results positive. The results of the study contribute to the literature on choice making and interventions for problem behaviors maintained by negative reinforcement by providing 3 different dimensions of reinforcement (i.e., quality and duration) for 3 concurrently available response options: compliance, communication, and problem behavior. The majority of published studies on choice making and interventions for problem behavior 173

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217 APPENDIX A INFORMATIONAL LETTER AND CONSENT FORM 196

218 February XX, 2005 Dear Parent/Guardian, I am a doctoral student in special education at The Ohio State University, and I am conducting a study in conjunction with the Franklin County Board of Mental Retardation and Developmental Disabilities (FCBMRDD) to identify effective treatments for problem behavior. A staff member at FCBMRDD nominated your son/daughter as someone who might benefit from our training and services at no charge. However, before enrolling your child in this project, we would like to tell you what is involved with the project and to gain your consent for your child s participation. Before implementing an intervention for problem behavior, our research team will conduct an assessment of your child s inappropriate behavior as part of our on-going consultation services with FCBMRDD. The assessment will help us understand why your son/daughter s problem behavior occurs and will guide our intervention procedures. Following the assessment, we will then match the intervention to the results of this assessment. In some cases problem behavior occurs for social reasons, for example an individual may engage in problem behavior to get out of an unpleasant situation, in these cases our intervention will focus on teaching the individual to request a break using some form of communication, for example, asking for a break, signing for a break, or touching a communication card. Sometimes, assessments show that problem behavior occurs to gain attention or gain access to activities or items or some combination of both getting out of something unpleasant and gaining something pleasant. In these cases, our intervention will focus on teaching your son/daughter to request a break to get attention or access to desirable items in a more appropriate manner. Once we have demonstrated success with the communication part of the intervention, it will be important for us to make sure that your son/daughter is able to continue to engage in meaningful work tasks and not just requesting breaks all the time. For this part of the intervention we will be changing the duration and quality of rewards associated with following directions and those associated with problem behavior and break requests. Complying with a work task will result in the longest duration and highest quality rewards, requesting break will result in a moderate duration and quality reward, and problem behavior will result in the shortest break and quality reward. This part of the intervention will be implemented to see if the arrangement of rewards will facilitate better choices over problem behavior for your son/daughter. Finally, we will 197

219 attempt to increase your son/daughter s engagement in functional work tasks by arranging a schedule of reinforcement where he/she gains the longest duration and highest quality break time for compliance, moderate break time for requesting breaks and the shortest duration and quality for engaging in problem behavior. Throughout the study, every effort will be made to ensure your son/daughter s safety. We will do this by making sure an adult is in close proximity to your child during all sessions. In addition we will monitor the frequency and intensity of any problem behavior and will terminate any sessions where it appears your son/daughter is in severe discomfort or distress. The appropriate parties (i.e., nursing staff, administrators) at the school your child attends will be notified immediately if this were to occur. All of our sessions will be videotaped for data collection purposes only. These videotapes will be viewed only by members of the research team associated with this project and will be kept in a locked box in a locked office when not in use. No personally identifiable information about your child will be on the tape (other than his/her image). If we ever want to show videotape to anyone else say at a professional conference we will request your written permission for doing so. You are always welcome to say no to such requests and doing so will not affect your son/daughter s participation in this project. If you do provide consent to have your child participate in this study and you change your mind later for any reason you are free to withdraw your consent and we will no longer collect any data on your son/daughter. Your decision to withdraw your child from the study will in no way affect our relationship with you or your child s teacher/care providers. We will be happy to help you find other services in the area to help you with your child s problem behavior if you wish you discontinue your child s participation in this study. If you agree to have your child participate in this study, please review and sign the attached consent form indicating your consent and return it in the enclosed envelope. We will be happy to share the results of our assessments/interventions with you and with other care providers who work with your child if you would like us to do so. Please feel free to contact us at any time if you would like us to do so. Also, please feel free to contact me at any time with any questions or concerns you may have regarding this project. You may contact me at or via at vannorman.1@osu.edu Sincerely, Renee K. Van Norman, M.S. Doctoral Candidate, Co-Investigator 198

220 CONSENT FOR PARTICIPATION IN SOCIAL AND BEHAVIORAL RESEARCH CONSENT TO INVESTIGATIONAL TREATMENT OR PROCEDURE Protocol title: The Effects of Functional Communication Training, Choice Making, and An Adjusting Work Schedule on Problem Behavior Maintained by Negative Reinforcement Protocol number: 2004BO404 Principal Investigator: Nancy A. Neef, Ph.D., Co Investigators: Stephanie M. Peterson, Ph.D., and Renee K. Van Norman, M.Ed. DESCRIPTION OF THE RESEARCH: 1. Description of the procedure or treatment. Reason for performing this procedure or treatment. Individuals who have moderate to severe developmental disabilities and limited communication skills present many challenging behaviors within the school and home environments. Individuals with severe developmental disabilities may engage in a variety of problem behavior sometimes called noncompliance, work refusals, or disruptions Noncompliance may take many forms, such as aggression towards others, self-injury, verbal and/or physical refusal and can directly impact a student s meaningful and active participation in academic and functional instruction. The study is designed to identify effective interventions for children who display problem behavior to get out of undesirable tasks. This study will take place in three phases. First, functional communication training will be implemented. This will consist of teaching an alternative communicative response that serves the same purpose as the problem behavior. For example, the student will be taught how to request breaks from task demands using either a sign for break, touching a communication card, or verbally asking for a break. Next, we will attempt to get the student to choose to do the work rather than request a break by providing a longer duration and higher quality break following task compliance than the breaks provided for engaging in problem behavior or requesting breaks. Once a student is successfully and independently requesting breaks 199

221 and/or complying with task requests with low to zero occurrences of problem behavior, we will gradually increase the time requirement for work tasks while adjusting the a work timer associated with problem behavior and break requests. During this phase the student will be provided with the longest duration and highest quality of break for engaging in the work task for the entire work period, and shorter lower quality breaks for break requests or/and problem behavior. 2. Participation in this study is optional and voluntary. Possible appropriate alternative procedures or treatment are: Physical or mechanical restraint can be used to keep the individual from engaging problem behavior. Interventions based on punishment have been shown in the literature to be very effective in some problem behaviors. Some have attempted using differential reinforcement of other behavior, functional communication training with an extinction component for problem behavior, and other reinforcement-based interventions. These procedures have been shown to be very effective in increasing appropriate social behaviors and decreasing inappropriate behaviors, when it is possible to ignore or redirect problem behavior. However, in some cases problem behavior is so severe that it cannot be ignored or redirected consistently or safely. In such cases choice-making interventions have been effective in biasing individuals responding toward appropriate alternatives, such as compliance or appropriate break requests. 3. Discomforts and risks that might reasonably be expected from participation in this study. We expect very few discomforts and risks from participation in this study. However, because the study deals with problem behavior, such as aggression or selfinjury, there is a small possibility that the individual will be at risk for bruising or similar. All precautions will be taken to avoid this. Researchers or staff will remain close to the participants throughout the research sessions to monitor the participants safety. If, at any time, the participant engages in such high rates of aggression or self-injury and there is the possibility of skin damage, the session will be terminated and the school nurse, administrator, and parents will be contacted immediately. 4. Possible benefits for participants or for society. Possible benefits for participants of this study include effective, proactive treatment of problem behavior and the reduction of the possible use of more restrictive intervention procedures. Benefits to society include the development of effective, proactive interventions for problem behavior maintained by escape from task demands and a better understanding of noncompliant behaviors. 5. Estimated amount of time it will take (number of sessions; length of each session, period of time). 200

222 We anticipate participants will spend approximately 15 minutes in study sessions, depending upon the phase of the study. We anticipate that at least 100 sessions may be needed to effectively provide assessment and intervention. We expect the study to take over the course of 5 months. These estimates may be over- or under-estimates, depending on the severity of the problem behavior and the individual's history of problem behavior (i.e., the longer the history of problem behavior usually indicates more resistance to intervention). We will work with the participants teachers, staff, and parents to identify times when we can conduct experimental sessions that will not interfere with the individual's ongoing routine and learning activities. 6. Use of audiotapes, videotapes or photographs to collect information for this study. Experimental sessions will be videotaped for data collection purposes only. These videotapes will be viewed only by the research team involved in this project and will not be shown to anyone else without your written consent. Videotapes will be stored in a locked box in a locked office and will be destroyed at the conclusion of the study. No identifying information (e.g., names) will be written on the videotapes. 7. Access to archival records such as academic records or medical records. List the information that will be obtained from these sources. Teachers and caregivers may be interviewed in order to gain information regarding participants ages, histories of problem behavior, previous intervention attempts, etc. However, it is not anticipated that the researchers will need access to academic or medical records. 201

223 CONSENT: I consent to my son s or daughter s participation in research being conducted by Nancy A. Neef, Ph.D. and Renee K. Van Norman of The Ohio State University and his/her assistants and associates. The investigator(s) has explained the purpose of the study, the procedures that will be followed, and the amount of time it will take. I understand the possible benefits, if any, of my son s or daughter s participation. The investigator(s) has explained the risks, if any, and I understand what they are. No guarantees have been made regarding the effectiveness of this treatment or procedure. I know that I can choose to withdraw my son s or daughter s participation in this study at any time without penalty to me or my child. If I give my consent for my son or daughter to participate, I can withdraw my son or daughter from the study at any time, and there will be no penalty. I consent to the use of audiotapes and/or videotapes. I understand how the tapes will be used for this study. I have had a chance to ask questions and to obtain answers to my questions. I can contact the investigators at neef.2@osu.edu. If I have questions about my rights as a research participant I can call the Office of Research Risks Protection at (614) I understand in signing this form that, beyond giving consent, I am not waiving any legal rights that I might otherwise have. My signature on this form does not release the investigator, the sponsor, the institution, or its agents from any legal liability for damages that they might otherwise have. 202

224 I have read this form or I have had it read to me. I sign it freely and voluntarily. A copy has been given to me. Print the name of the participant: Date: Signed: (Principal Investigator or his/her authorized representative) Signed: (Participant) Signed: (Person authorized to consent for participant, if required) Witness: (When required) 203

225 APPENDIX B LETTER OF SUPPORT, PERMISSION TO CONDUCT RESEARCH, AND FCBMR/DD AND OSU IRB APPROVAL LETTER 204

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229 APPENDIX C SAMPLE DATASHEETS 208

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235 APPENDIX D BLANK FUNCTIONAL ANALYSIS INTERVIEW FORM AND ABC ASSESSMENT FORM 214

236 FUNCTIONAL ANALYSIS INTERVIEW FORM (modified O Neill et al., 1997) Person of concern Age Sex M F Date of interview Interviewer Respondents A. DESCRIBE THE BEHAVIORS. 1. For each of the behaviors of concern, define the topography (how it is performed), frequency (how often it occurs per day, week, or month), duration (how long it lasts when it occurs), and intensity (how damaging or destructive the behaviors are when they occur). Behavior Topography Frequency Duration Intensity 2. Which of the behaviors described above are likely to occur together in some way? Do they occur about the same time? In some kind of predictable sequence or "chain"? In response to the same type of situation? B. DEFINE ECOLOGICAL EVENTS (SETTING EVENTS) THAT PREDICT OR SET 215

237 UP THE PROBLEM BEHAVIORS. 1. What medications is the person taking (if any), and how do you believe these may affect his or her behavior? 2. What medical or physical conditions (if any) does the person experience that may affect his or her behavior (e.g., asthma, allergies, rashes, sinus infections, seizures, problems related to menstruation)? 3. Describe the sleep patterns of the individual and the extent to which these patterns may affect his or her behavior. 216

238 4. Describe the eating routines and diet of the person and the extent to which these may affect his or her behavior. 6a. Briefly list below the person's typical daily schedule of activities. (Check the boxes by those activities the person enjoys and those activities most associated with problems.) DAILY SCHEDULE Time Enjoys: Problems: 5b. To what extent are the activities on the daily schedule predictable for the person, with regard to what will be happening, when it will occur, with whom, and for how long? 217

239 5c. To what extent does the person have the opportunity during the day to make choices about his or her activities and reinforcing events? (e.g., food, clothing, social companions, leisure activities) 6. How many other persons are typically around the individual at home, school, or work (including staff, classmates, and housemates)? Does the person typically seem bothered in situations that are more crowded and noisy? 7. What is the pattern of staffing support that the person receives in home, school, work, and other settings (e.g., 1:1, 2:1)? Do you believe that the number of staff, the training of staff or their social interactions with the person affect the problem behaviors? 218

240 C. DEFINE SPECIFIC IMMEDIATE ANTECEDENT EVENTS THAT PREDICT WHEN THE BEHAVIORS ARE LIKELY AND NOT LIKELY TO OCCUR. 1. Times of Day: When are the behaviors most and least likely to happen? Most likely: Least likely: 2. Settings: Where are the behaviors most and least likely to happen? Most likely: Least likely: 3. People: With whom are the behaviors most and least likely to happen? Most likely: Least likely: 4. Activity: What activities are most and least likely to produce the behaviors? Most likely: Least likely: 5. Are there particular or idiosyncratic situations or events not listed above that 219

241 sometimes seem to set off the behaviors, such as particular demands, noises, lights, clothing? 6. What one thing could you do that would most likely make the undesirable behaviors occur? 7. Briefly describe how the person's behavior would be affected if... a. You asked him or her to perform a difficult task. b. You interrupted a desired activity, such as eating ice cream or watching TV. c. You unexpectedly changed his or her typical routine or schedule of activities. 220

242 d. She or he wanted something but wasn't able to get it (e.g., a food item up on a shelf). e. You didn't pay attention to the person or left him alone for a while (e.g., 15 min). D. IDENTIFY THE CONSEQUENCES OR OUTCOMES OF THE PROBLEM BEHAVIORS THAT MAY BE MAINTAINING THEM (I.E., THE FUNCTIONS THEY SERVE FOR THE PERSON IN PARTICULAR SITUATIONS). 1. Think of each of the behaviors listed in Section A, and try to identify the specific consequences or outcomes the person gets when the behaviors occur in different situations. Behavior Particular Situations What exactly does he/she get? What exactly does he/she avoid? 221

243 E. CONSIDER THE OVERALL EFFICIENCY OF THE PROBLEM BEHAVIORS. EFFICIENCY IS THE COMBINED RESULT OF (A) HOW MUCH PHYSICAL EFFORT IS REQUIRED, (B) HOW OFTEN THE BEHAVIOR IS PERFORMED BEFORE IT IS REWARDED, AND (C) HOW LONG THE PERSON MUST WAIT TO GET THE REWARD. Low Efficiency High Efficiency F. WHAT FUNCTIONAL ALTERNATIVE BEHAVIORS DOES THE PERSON ALREADY KNOW HOW TO DO? 1. What socially appropriate behaviors or skills can the person already perform that may generate the same outcomes or reinforcers produced by the problem behaviors? G. WHAT ARE THE PRIMARY WAYS THE PERSON COMMUNICATES WITH 222

244 OTHER PEOPLE? 1. On the following chart, indicate the behaviors the person uses to achieve the communicative outcomes listed: Communicative Complex Speech Multiple-word phrases One-word utterances Echolalia Other vocalizing Complex signing Single signs Pointing Leading Shakes head Grabs/reaches Gives object Increased movement Moves close to you Moves away or leaves Fixed gaze Facial expression Aggression Other Request Attention Request help Request preferred Food/obj/activities Request break Show you something or some place Indicate physical pain (headache/illness) Indicate confusion or unhappiness Protest or reject situation or activity 223

245 2. What are the general expressive communication strategies used by or available to the person? These might include vocal speech, signs/gestures, communication boards/books, or electronic devices. How consistently are the strategies used? 3. With regard to the person's receptive communication, or ability to understand other persons... a. Does the person follow spoken requests or instructions? If so, approximately how many? (List if only a few.) b. Does the person respond to signed or gestural requests or instructions? If so, approximately how many? (List if only a few.) c. Is the person able to imitate if you provide physical models for various tasks or activities? (List if only a few.) d. How does the person typically indicate yes or no when asked if she or he wants something, wants to go somewhere, and so on? 224

246 H. WHAT ARE THINGS YOU SHOULD DO AND THINGS YOU SHOULD AVOID IN WORKING WITH AND SUPPORTING THIS PERSON? 1. What things can you do to improve the likelihood that a teaching session or other activity will go well with this person? 2. What things should you avoid that might interfere with or disrupt a teaching session or activity with this person? I. WHAT ARE THINGS THE PERSON LIKES AND ARE REINFORCING FOR HIM OR HER? 1. Food items: 2. Toys and objects: 3. Activities at home: 225

247 4. Activities/outings in the community: 5. Other: J. WHAT DO YOU KNOW ABOUT THE HISTORY OF THE UNDESIRABLE BEHAVIORS, THE PROGRAMS THAT HAVE BEEN ATTEMPTED TO DECREASE OR ELIMINATE THEM, AND THE EFFECTS OF THOSE PROGRAMS? Behavior How long has this been a problem? Programs? Effect? 226

248 K. DEVELOP SUMMARY STATEMENTS FOR EACH MAJOR PREDICTOR AND/OR CONSEQUENCE. Distant Immediate Antecedent Problem Behavior Maintaining Setting (Predictor) Consequence Event 227

249 ABC Assessment Sheet Appendix I Samples of Blank Preference Assessment Data Sheets 228

250 APPENDIX E SAMPLE PREFERENCE ASSESSMENT DATASHEETS 229

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255 APPENDIX F SECONDARY OBSERVER RECRUITMENT LETTER AND DESCRIPTION OF RESEARCH 234

256 April 3, 2005 Dear OSU Faculty Member, I am a doctoral student in special education at The Ohio State University, and I am conducting my dissertation in conjunction with the Franklin County Board of Mental Retardation and Developmental Disabilities (FCBMRDD) to identify effective treatments for problem behavior. Specifically, I will be investigating the effects of a functional communication training program, choice making, and an adjusting work schedule on problem behavior maintained by negative reinforcement (see attached description of research). I am very much in need of assistance in collecting data for my dissertation. I am writing to recruit student volunteer data collectors, for primary and interobserver agreement measures of the dependent variables, as well as, treatment integrity measures of the independent variables. I would need the student to commit to no less than 2 to 3 hours per week for data collection purposes. Fortunately, all of my data will be videotaped, so the time of day during which students can score data is very flexible. In addition, little travel is needed for students as they can score videotapes on campus or at home (rather than traveling out to the local schools). Each student volunteer will be provided with a series of 30 to 60- min individual or group pre-data collection training sessions location to be determined. The study is set to begin A.S.A.P. and I expect sessions and data collection to run until 6/10/2005. I would need your student volunteer to be committed to at least ½ of this calendar time or for 1 quarter. Having stated all the requirements and responsibilities, I regret to say that I have no compensation to offer at this time for your students commitment to this project other than the possibility of co-authorship on any (and all) publications that may be a product of this research in the future (depending on the level of commitment and work provided by the student volunteer) and any assistance that I can provide, such as tutoring, in data collection or other related course material. Dr. Neef is willing to provide students who volunteer with independent study credits if the student desires them (1 credit per 30 hours of work). Alternatively, if you have a course that is running simultaneously with the dates specified in this letter and you would be willing to provide extra credit for student participation, I would be very appreciative. I would be happy to work with you on identifying a fair and reasonable system for tracking student volunteer time and work products. I think this is a wonderful opportunity for your students to be exposed to and gain skills in data collection, data analysis, functional analysis, preference assessment methods, 235

257 functional communication training, and choice making analyses. I hope that you will encourage your students to take part in this scientific activity. If, after speaking with your students, you or potential volunteers have any questions or concerns, or your student would like to volunteer, or would just like more information, please have them contact me by XXXXo or by phone (614) Thank you in advance for your diligent recruitment attempts. Sincerely, Renee K. Van Norman Doctoral Candidate The Ohio State University Enc: Description of research 236

258 Description of Research to be Included with Student Volunteer Recruitment Letter Student Investigator: RENEE K. VAN NORMAN Title of the investigation: The Effects of Functional Communication Training, Choice Making, and An Adjusting Work Schedule on Problem Behavior Maintained by Negative Reinforcement Purpose of the study: The purposes of this study are to (a) evaluate the participants sensitivity to different dimensions of reinforcement (i.e., quality and duration) associated with three concurrently available response alternatives (e.g., compliance to task requests [engagement], mands [requests for breaks], and problem behavior) during FCT programs for problem behaviors maintained by negative reinforcement; and (b) compare the effects of systematic increases in work requirements on compliance (engagement), problem behavior, and break requests (mands) when FCT is in place versus when it is not in place (i.e., DRA). Research questions the study will address: What are the effects of different qualities and durations of reinforcement on response allocation between problem behavior, break requests, and compliance (engagement)? Specifically, what are the effects of increasing the duration and quality of reinforcement for break requests and compliance relative to that for problem behavior? Given that participants display an increase in compliance (engagement) or break requests over problem behavior when compliance and break requests receive higher quality and duration of reinforcement than problem behavior, what are the effects of systematically increasing work requirements on response allocation to task compliance (engagement), break requests (mands), and problem behavior when FCT is in place (3-choice scenario) versus when it is not in place (2-choice scenario, i.e., DRA)? What are relevant consumers perceptions about the procedures, results, and feasibility of implementing functional communication training and choice making as an intervention to increase task compliance and reduce problem behavior? Setting: This study will take place at two of FCBMR/DD s school-age teaching facilities Northeast School, 500 North Hamilton Road, Gahanna, OH 43230; and West Central School, located at 1481 W. Town St., Columbus, OH

259 APPENDIX G SAMPLES OF BLANK AND COMPLETED PROCEDURAL INTEGRITY DATASHEETS AND DIRECTIONS FOR SCORING 238

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266 APPENDIX H BLANK TARF AND SOCIAL VALIDITY SURVEY FORMS 245

267 DIRECTIONS: TREATMENT ACCEPTABILITY RATING FORM (Revised TARF) By Thomas Reimers and David Wacker (1988) Modified by Susan Silvestri (2003) and Renee Van Norman (2004) Please listen to the procedure description and complete the items listed on the following pages of this rating form. The items should be completed by placing a check mark on the line under the question that best indicates how you feel about the recommended strategies that you have just heard. If you have specific concerns that are not addressed in the rating form or have suggestions to add to the protocol, please use the line under each item to provide the author of the protocol with specific feedback. You DO NOT need to provide additional feedback on the lines for all items, just those that you have specific concerns about. If a particular question does not apply to you please indicate that you have read the question by writing N/A next to the question. If you have any questions or concerns regarding this rating form please discuss your concerns with Renee Van Norman. Thank you in advance. Your opinions and feedback will help us to develop behavior support plans that are most effective and most useful for you and your learner. Sincerely, Renee K. Van Norman Date received: Date completed: Name (optional): Relation to the learner (optional): Best way to contact you (optional): 246

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274 APPENDIX I COPY OF CONSENT FORM FOR PARTICIPATION IN SOCIAL VALIDITY MEASURES 253

275 CONSENT FOR PARENT/TEACHER PARTICIPATION IN SOCIAL AND BEHAVIORAL RESEARCH CONSENT TO INVESTIGATIONAL ASSESSMENT FOR TREATMENT ACCEPTABILITY PURPOSES Protocol title: The Effects of Functional Communication Training, Choice Making, and An Adjusting Work Schedule on Problem Behavior Maintained by Negative Reinforcement Protocol number: 2004B0404 Principal Investigator: Nancy A. Neef, Ph.D., Co Investigator Renee K. Van Norman, M.S., College of Education DESCRIPTION OF THE RESEARCH: 1. Description of the treatment acceptability assessment and reasons for performing the assessment: Measures of acceptability of the treatment will be obtained by the distribution and analysis of a consumer opinion survey. A modified version of The Treatment Acceptability Form (TARF-R; Reimers & Wacker, 1988) highlighting the procedures and impact of the proposed intervention will be used to evaluate relevant consumer opinions of the study (see Appendix E ). In order to evaluate treatment acceptability, acceptability forms will be distributed to each of the consenting participant s teachers, paraprofessional staff, parents/guardians, and FCBMR/DD behavior support staff, who will complete them and return them to the experimenter. Consent forms for participation will be obtained from each participant (e.g., caregiver, parent) prior to assessing acceptability. This portion of the study is designed to evaluate the social validity of the intended purpose of the intervention, effects of the intervention procedures, and results of this study, a number of steps will be taken to obtain the opinions of relevant consumers, both those directly involved (i.e., parent or teachers whose child is a participant) and those not directly involved (i.e., other teachers and administrators from the educational setting) with the study.. 2. Participation in this assessment is voluntary. Consumer opinion is one way in which the social validity of an intervention procedure can be assessed (Wolf, 1978). Teacher, parent, and/or caregiver participation in this portion of the study will provide the investigators with information regarding the opinions of parents, teachers, and care providers as they relate to the acceptability of the purposed intervention procedures, the results of which will add to the social validity of this study. Your participation in the treatment 254

276 acceptability survey associated with this research project is completely voluntary. If you do not wish to participate or at anytime change your mind about participation there will be no penalty to you or your son/daughter. 3. Discomforts and risks that might reasonably be expected from participation in this study. There are no discomforts or risks associated with the treatment acceptability portion of this study. 4. Possible benefits for participants or for society. Possible benefits for participants of this portion of the study include a better understanding of consumer opinions on effective, proactive treatment of problem behavior. Benefits to society include the development of effective, proactive interventions for problem behavior maintained by escape from task demands and a better understanding of noncompliant behaviors. 5. Estimated amount of time it will take (number of sessions; length of each session, period of time). We suggest completing the acceptability form during more than one session; however it can be completed within minutes. We will work with the consenting participants of this portion of the study to identify a timeline for when we can expect the form to be completed so that its completion does not interfere with a parent, teacher, or care providers schedule. 6. Use of audiotapes, videotapes or photographs to collect information for this study. Videotapes are part of this study; however no portion of the videos will be used to assess treatment acceptability. No audio (voice) and/ or video tapes (image) of treatment acceptability participants will be used in this assessment. 7. Access to archival records such as academic records or medical records. List the information that will be obtained from these sources. Teachers and caregivers are the respondents to the treatment acceptability questionnaire. Teachers and caregivers will be asked to read an intervention protocol and then complete the acceptability questionnaire. No other information will be collected for this part of the study. 255

277 Consent for participation Consents will be obtained from all parent and teacher participants using the parent/teacher treatment acceptability consent form. CONSENT: I consent to my participation in the treatment acceptability research being conducted by Nancy A. Neef, Ph.D. and Renee K. Van Norman, M.S. of The Ohio State University and his/her assistants and associates. The investigator(s) has explained the purpose of the treatment acceptability portion of the study, the procedures that will be followed, and the amount of time it will take. I understand the possible benefits, if any, of my participation. The investigator(s) has explained the risks, if any, and I understand what they are. No guarantees have been made regarding the results of the treatment acceptability assessment. I know that I can choose to withdraw my participation in this study at any time without penalty to me or my child/student. If I give my consent for my participation, I can withdraw myself and my son/daughter from the study at any time, and there will be no penalty. Although no audio and/ or video tapes of my voice or image will be used in this assessment, I consent to the use of audiotapes and/or videotapes. I understand how the tapes will be used for this study. I understand that I will be provided with an opportunity to review any procedures or video clips if my son/daughter s session video clips are selected for social validity assessment purposes. I also understand that if I give consent for video release, I can withdraw my consent at any time, and there will be no penalty. I have had a chance to ask questions and to obtain answers to my questions. I can contact the investigators at neef.2@osu.edu. If I have questions about my rights as a research participant I can call the Office of Research Risks Protection at (614) I understand in signing this form that, beyond giving consent, I am not waiving any legal rights that I might otherwise have. My signature on this form does not release the investigator, the sponsor, the institution, or its agents from any legal liability for damages that they might otherwise have. 256

278 I have read this form or I have had it read to me. I sign it freely and voluntarily. A copy has been given to me. Print the name of the participant: Date: Signed: (Principal Investigator or his/her authorized representative) Signed: (Participant) Signed: (Person authorized to consent for participant, if required) Witness: (When required) I do not wish to consent to my participation in the investigational assessment of treatment acceptability. 257

279 APPENDIX J SAMPLE OF A COMPLETED SOCIAL VALIDITY SURVEY 258

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