Presentation on theme: "Communication Assessment for People who engage in Behaviours Of Concern (BOC) Module 5 : Functional Communication Training Hilary Johnson, Nick Hagiliassis,"— Presentation transcript:
Communication Assessment for People who engage in Behaviours Of Concern (BOC) Module 5 : Functional Communication Training Hilary Johnson, Nick Hagiliassis, Barbara Solarsh, Teresa Iacono, Jo Watson, Teena Caithness Office of the Senior Practitioner, Disability Services, Victoria
Functional Communication Training (FCT) CRITICAL QUESTION What are the differences between functional communication training (FCT) and teaching an individual to communicate in everyday situations (with a variety of partners, in a variety of settings)? What are the similarities?
Functional Communication Training (FCT) FCT defined as a systematic intervention in which the behavior of concern is replaced by more socially appropriate behavior. (Sigafoos & Meikle, 1996) –Replacement behavior is intended to serve the same purpose as the challenging behavior (Carr, 1988) –Underlying notion that challenging behaviors are communicative intents (Durand, 1993; Skinner, 1957) MAND
Functional Equivalence Myth #1 If I teach the person to communicate, unacceptable behaviour will no longer occur. Fact #1 Teach a mand that serves the same function as the unacceptable behaviour. The relationship between the mand and unacceptable behaviour is the key variable.
StepDescriptionRationale 1. Identify the functions of the unacceptable behaviour Conduct a functional analysis of the unacceptable behaviour If function is known, then use a response that is functionally equivalent. 2. Ensure the efficiency of the communicative responses that compete with unacceptable behaviour Select a efficient communication response 1) physical effort 2) amount of reinforcement and 3) delay to reinforcement ↑ effort &/or ↓ response &/or greater delay to reinforcement for communicative response, then no change to behaviour 3. Evaluate the reinforcers provided for unacceptable behaviour and communicative responses Eliminate or ↓reinforcement for the unacceptable behaviour and ↑ reinforcement for the communicative response = effort = response = reinforcement Both will occur
Functional Communication Training Kenneth hits his Mum with a closed fist Request for “Take me for a drive in the car” Teach Kenneth to sign “car” as a request BOCFunctionFCT Select KWS as a mand Review
Behaviour Effort of Response Delay to Reinforcement Aggression (hitting his mother) Kenneth must approach his mother and move his hand to his mother’s face or body Minimal Signing “car”Less than aggression however he is already fisting his hands * Longer than aggression (must be observed) Touching a word cardLess than aggressionLonger than aggression (must be observed) Using a voice output communication aid Less than aggressionSame as aggression (gives an auditory cue to his mother if message matches intent)
ProcedureFunctional description Functional effect Reprimand, redirect, or discuss Kenneth is given attention by his mother, although he does not go in the car Hitting is reinforced Reduce amount / quality of attention Brief neutral attention provided for hitting. More attention given for use of KWS Reinforcement occurs, but the relative value & amount of reinforcement weakens the behaviour Planned ignoring (extinction) Hitting is ignoredReinforcement of hitting is eliminated Time-out (nonexclusionary) Mother looks away for a brief period for time (eg: 30 seconds) whenever hitting occurs Reinforcement of hitting is eliminated, and Kenneth receives no attention for a brief period
Functional Communication Training FCT involves assessment to determine the functions of behaviour and teaching the use of a more appropriate form of behaviour that serves the same function. There are 3 stages: 1.Identify the Communicative Function of the BOC 2.Select an appropriate communicative alternative 3.Implement systematic instruction to teach the communicative alternative
FCT Systematic Review of Literature Miriam Chacon & Oliver Wendt (2006) Evidence Based Practice (EBP) –Provide evidence about the effectiveness of FCT for practitioners –Provide a systematic review which uses quantitative measures to determine treatment effectiveness Last review published in 1997 (Mirenda) Research Question –Is FCT an effective treatment in decreasing aggressive behaviors in individuals with autism?
FCT Systematic Review of Literature Miriam Chacon & Oliver Wendt (2006) Speech (n=3) Vocalizations – replacement behaviour* Braithwaite & Richdale (2000) Day, Horner, & O’Neill (1994) Sigafoos & Meikle (1996) Manual Signs & Gestures (n=3) A combination of ASL manual signs and gestures* Day, Horner, & O’Neill (1994) Sigafoos & Meikle (1996) Wacker, et al. (1990) Graphic Symbols (n=3) Line drawings and word cards* Horner & Day (1991) Schindler & Horner (2005) Sigafoos & Meikle (1996)
FCT Systematic Review Results Miriam Chacon & Oliver Wendt (2006) FCT ranged from fairly effective to highly effective in the studies reviewed FCT yielded greater reduction of challenging behaviors when speech & manual signs/gestures were used as the replacement behaviors –graphic symbols yielded the least amount of reduction of challenging behaviours TABLE Median PNDPRD speech97%98% manual signs & gestures100% graphic symbols65%88%
Functional Communication Training FCT is successful although alone, it does not produce changes in the long run if other measures are not also addressed. Fading, extinction and other measures should be combined to ensure that the individuals continue to gain other skills while decreasing the use of challenging behaviours (Carr & Durand, 1985; Wacker et al, 1990) Continues research on FCT is needed Boesch, M. C. & Wendt, O. (2009) Reducing self-injurious behaviors in individuals with autism: Benefits of functional communication training EBP Briefs 4(2), 1-11.
Where does FCT fit into a BSP? Under the section Proactive Strategies “Teaching Skills” Communication Skills Independence * Coping skills * However, you may also be working on receptive and expressive communication supports for independence and coping skills in the three proactive strategy areas Change the Environment, Teaching Skills and Short-term Change Strategies
Functional Communication Training Proactive strategies What to do to prevent the behaviour Immediate response strategies What might help when the behaviours occur; beginning with least restrictive strategies? Change the environment Train communication partners to look for new skill Add resources to support FCT Teaching skills Teach new skill to replace BOC (long term) Short-term change strategies for rapid change to behaviour Teach new skill to replace BOC (immediate) Do not expect the individual to use FCT Follow BSP
SUMMARY Pat Howlin (2006) pages 90-97 Developing communication in less able individuals Examining communicative functions important in BoC Analysis of “maladaptive” behaviours finds they are often most effective BoC lead to rapid and usually predictable responses from others Highly intensive experimental settings → lead to teach alternative ways (FCT) Detailed analysis of possible functions of undesirable behaviours required Quick fix 4 functions: Durand & Crimmins (1988) Motivational Assessment Scale Identify primary function of behaviour → alternate forms taught (FCT) Increasing general communicative ability –Transition from school to adulthood –Need to recognise an individual’s potential ability Possible to teach emotions – better if you start young
Transporters Prof Simon Baron-Cohen http://www.thetransporters.com/index.html
The CAT Kit Dr Tony Attwood http://catkit-us.com/ Developed by Dr. Tony Attwood, Dr. Kirsten Callesen and Dr. Annette Moller Nielsen Cognitive Affective Training (CAT) visual representation of feelings and emotions Includes a Manual, CAT-organizer, 9 Basic Feelings, The Measure, the Body, My circles, Timetables, Behaviour Palettes, the Wheel, CAT-book labels
Emotion Based Social Skills Training EBSST http://sigmaweb.com.au/westmead/ 2004 HFASD + AS children 8-14 years + parents Pilot Study 2006 HFASD + AS children 8-14 years + parents RCT 2008 ASD + ID children 8-12 years + parents Pilot Study 2010 EBSST in Schools 7-12 years + parents Pilot Study To Contact EBSST - Email us at: firstname.lastname@example.org Fax us at : 02 9845 2009 Call us at : 02 9845 email@example.com
Dr Karen James University of Sydney firstname.lastname@example.org http://www.abc.net.au/rn/edpod/stories/2010/2938834.htm 22 July 2010 Learning to communicate at school http://www.abc.net.au/rn/lifematters/stories/2010/2959173.htm 21 July 2010 Adolescents 12-16 years – Western Sydney
The Good Way Model Lesley Ayland and Bill West, NZ http://www.nzfvc.org.nz/accan/papers-presentations/abstract261v.shtml Strengths-based model Uses Narrative therapy Originally developed for young people with DD Good Way Good House / Bad House Good Life Gang of 3 for abusive behaviour Mr Sneaky, Mr Bully, Mr Just Do The 3 Wise Men and their Box of Tools http://wellstop.org.nz/
Dr Pat Mirenda University of British Columbia email@example.com Worth seeing if you ever get a chance Possible visit to Australia in 2011 Planting Two Trees with One Seed: Communication supports for Problem Behaviour (2008) http://www.ussaac.org/allthatjazzdocs/AACATJ.08.HO1.pdf http://www.ussaac.org/allthatjazzdocs/AACATJ.08.HO2.pdf
References Sigafoos, J., Arthur-Kelly, M. & Butterfield, N (2006) Enhancing Everyday Communication for Children with Disabilities (2006) Paul H. Brookes Publishing Co: Maryland USA ISBN 1-55766-716-0 Koegel, L.K., Koegel, R.L & Dunlap, G. (1996) Positive Behavioral Support: Including People with Difficult Behavior in the Community Paul H. Brookes Publishing Co: Maryland USA ISBN 1-55766-228-2
References Howlin, P. (2004) Autism and Asperger Syndrome: Preparing for Adulthood (2nd edn) London: Routledge. ISBN 0041530968 9 Reichle, J., Beukelman, D.R., & Light, J.C. (2002) Exemplary Practices for Beginning Communicators: Implications for AAC Paul H. Brookes Publishing Co: Maryland USA ISBN 1-55766-529-X
Focus Questions Functional Communication Training (FCT) Who assesses the behaviour? Who provides a hypothesis for the function of the behaviour? Who decides on the replacement behaviour? Who creates the communication supports or strategies? Who trains the replacement behaviour? Who collects data to support the effectiveness or not of the replacement behaviour? Who reviews the success or not of FCT?