1. Discrete -Trial Functional Analysis of Problem Behavior and Functional Communication Training in Three Adults with a Dual Diagnosis of an Intellectual Disability and a Mental Illness
LAURA C. CHEZAN

2. INTRODUCTION

3. Intellectual Disability
Context
Intellectual Disability
Mental
Illness
Dual Diagnosis
Problem Behavior

4. Context Cont’d Approach to Problem Behavior BEHAVIORAL INTERVENTIONS
Behavior is influenced by environmental variables
1. Assess to identify function
2. Teach replacement behavior

5. Participants’ Selection
All Participants
Behavioral Assessment
Intervention (FCT)
Discrimination Assessment
Functional Assessment
Trial-Based Functional Analysis

6. PARTICIPANTS AND SETTINGS

7. Participants’ Selection
Meeting with directors
Informal observation of potential participants
Meeting with staff members
Selection of participants

8. Participants’ Characteristics
Age
Diagnosis
Problem Behavior
Antoine 27
moderate ID
bipolar-disorder
autism
SIB
repetitive verbal and motor behavior
Rick 32
profound ID
mood disorder
physical aggression
property destruction
Tonya 23
severe ID
psychosis NOS
snatching food
Note: ID = intellectual disability; SIB = self-injurious behavior

9. Assessment & Training Setting
Settings
Participant
Type of Program
Location
Assessment & Training Setting
Antoine
day program
rural
dining room, instructional room
Rick
dining room, instructional room, hallway
Tonya
workshop
urban
work areas, dining area

10. ASSESSMENT AND ANALYSIS OF PROBLEM BEHAVIOR

11. Functional Assessment (FA)
PURPOSE
Collect information
Background Information
Topography of problem behavior
Environmental variables
Develop Hypotheses

12. FA – Methods and Outcomes
Background information
Record Review
INDIRECT METHODS
Definitions
Hypotheses
Interview
(FAI; O’Neill et al., 1997)
Temporal Relationships
Verify Hypotheses
ABC observations
(Bijou, Peterson, & Ault, 1968)
DIRECT METHODS

13. FA - DTFA
Hypotheses
Develop DTFA
Test Hypotheses
DTFA

14. DTFA - Conditions Antoine’s FA Hypotheses Rick’s FA Hypotheses
Tonya’s FA Hypotheses
Attention
Automatic Reinforcement
Attention
Tangible 1
Tangible 2
Attention
Tangibles

15. + FA HYPOTHESIS ANTECEDENT (No Access to Reinforcer) CONSEQUENCE
DTFA Components
ASSESSMENT ( 2 min) +
REINFORCEMENT (2 min)
Present Antecedent  STOP if:
(a) problem behavior
(b) time elapsed
Present Consequence hypothesized to maintain problem behavior

16. Automatic Reinforcement
DTFA - Protocols
Antoine
Rick
Tonya
Attention
Automatic Reinforcement
Attention
Tangible 1
Tangible 2
Attention
Tangibles

17. Target Behavior and Recording System
Problem Behavior
No Response
Occurrence or non-occurrence of the 2 responses (data sheet)
Latency to first response

18. DTFA Implementation WHO?
researcher, staff member, or behavioral consultant
WHEN?
naturally-occurring opportunities during typical routines throughout the day
HOW?
1-5 trials per day under one or multiple conditions
wait min between trials

19. What Did We Anticipate?
ASSESSMENT (No access to reinforcer) REINFORCEMENT (Access to reinforcer)
 Problem behavior
 Few or No Problem behavior

20. RESULTS

22. Latency to Problem Behavior

23. OUTCOME – Information about:
Social Validity
WHO?
HOW?
WHEN?
Staff
Questionnaire
End of assessment
OUTCOME – Information about:
Significance of outcomes
Appropriateness of procedures
Continuation of procedures in the future

24. Social Validity Interfered with other responsibilities (M=1.5)
Procedures were clear
Interested in learning more (M=3.5)
Took a long time (M=1.0)
Easy to conduct (M=3.0)
SD (1)
SA(4)
D (2)
A (3)

25. DISCUSSION

26. Effectiveness of DTFA
Clear patterns of behavior for all three participants
Applicable to adults with dual diagnosis
Few number of trials across conditions
Variability in the topography of problem behavior and number of trials with problem behavior

27. Factors That May Have Influenced Variability in the Topography of Problem Behavior and Number or Trials with Problem Behavior
Variations in stimulus control
Individual motivation
Fluctuation in the reinforcing value of certain people, items, or activities

28. Latency to First Occurrence of Problem Behavior
Efficient and less intrusive way to determine the function of problem behavior
Guide the delivery of reinforcement during intervention and increase tolerance for delayed reinforcement

29. Social Validity Implemented by staff members
Embedded within typical routines
Rated by staff members as:
Easy to implement
No time consuming

30. CONCLUSION

31. Conclusion
DTFA was effective in identifying the function of problem behavior for all three adults

32. FUTURE STUDIES

33. Future research may include:
Staff training for implementation of DTFA
Replication of findings

34. FUNCTIONAL COMMUNICATION TRAINING (FCT)

35. FCT STEPS Identification of replacement behavior
Teaching replacement behavior
Identification of replacement behavior

36. Identification of Functionally Equivalent Replacement Behavior
Reviewed DTFA results
Consulted with staff members
Identified a behavior that was easily discriminable and functionally equivalent
Defined behavior

37. Teaching the Replacement Behavior
Develop Instructional Procedures
Assess Current Level of Performance
Provide Instruction and Progress Monitoring
Constant time delay
Differential reinforcement
Error correction
BASELINE Protocol and Data Sheet
INTERVENTION Protocol and Data Sheet
8 opportunities
Daily routines
Behavioral indication
Researcher & staff
Protocol

38. Target Behavior and Recording System
Prompted Response or Problem Behavior
Independent Response
Occurrence or non-occurrence
of the two responses for each opportunity (data sheet)

39. RESULTS

41. RESULTS

42. Discrimination Assessment
Identify Example and Non-Example Discrimination Probes and Develop Protocol
Administer Probes and Collect Data

43. Discrimination Probes
100% across all participants for both example probes and non-example probes

44. OUTCOME – Information about:
Social Validity
WHO?
HOW?
WHEN?
Staff
Questionnaire
End of study
OUTCOME – Information about:
Significance of outcomes
Appropriateness of procedures
Continuation of procedures in the future

45. Social Validity
Benefited from learning a new response and it reduces the frequency of PB
Willing to continue the intervention
(M=3.0)
Interfered with other responsibilities (M=2.0)
Easy to conduct (M=2.5)
PB affected QOL (M=3.5)
SD (1)
SA(4)
D (2)
A (3)

46. DISCUSSION

47. Effectiveness of FCT Applicable to adults with dual diagnosis
Mental illness may influence the acquisition pattern of some adults with dual diagnosis
Effective in producing acquisition of a replacement behavior for all three adults

48. Factors That May Influence Different Acquisition Patterns
Response competition
Variations in stimulus control
History of reinforcement

49. Discriminated Use of the Replacement Behavior
Teach in the presence of behavioral indication
Increases the likelihood of the precise use of replacement behavior

50. Social Validity Implemented by staff members
Embedded within naturally-occurring opportunities
Rated as:
Beneficial for participants
Relatively easy to implement
No time consuming

51. CONCLUSIONS

52. Conclusions
FCT produced acquisition of a functionally equivalent replacement behavior
FCT produced discriminated use of the newly acquired replacement behavior

53. FUTURE STUDIES

54. Future research may include
Relationship between behavioral indication and generalization of replacement behavior
Staff training to identify teaching opportunities
Replication of findings

55. ?

56. Thank You!