Cipani functional behavior assessment pdf

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3The Cipani Behavioral Classification System

Objectives

• Students will be able to identify the four major diagnostic categories of problem behavior, and define each in terms of the establishing operation (EO) and functional relationship between behavior and its relevant abolishing operation (AO)

• Students will be able to identify the two Direct Access (DA) functions, and define each in terms of the EO, and functional relationship between behavior and its relevant AO

• Students will be able to identify the three Socially Mediated Access (SMA) functions, and define each in terms of the EO, and functional relationship between behavior and its relevant AO

• Students will be able to identify the four Direct Escape (DE) functions, and define each in terms of the EO, and functional relationship between behavior and its relevant AO

• Students will be able to identify the four Socially Mediated Escape (SME) functions, and define each in terms of the EO, and functional relationship between behavior and its relevant AO

• Students will be able to identify the factors involved in deciding the function and diagnostic category of problem behavior, that is, reliable relation between problem behavior and relevant outcome under a given EO, as well as the efficiency of such behaviors relative to other behaviors in producing such an outcome

• Students will be able to delineate how a given topography or form of behavior can be multi-functional

Chapter 3 Behavior Analysis Certification Board (BACB) Task List

4th edition 5th edition • I-05 Organize, analyze, and interpret

observed data

• I-06 Make recommendations regarding behaviors that must be established, maintained, increased, or decreased

• I-02 Define environmental variables in observable and measurable terms

• F-6 Describe the common functions of problem behavior.

• F-9 Interpret functional assessment data.

Cipani, E. P. (2017). Functional behavioral assessment, diagnosis, and treatment, third edition : a complete system for education and mental health settings. Retrieved from http://ebookcentral.proquest.com Created from snhu-ebooks on 2018-10-18 20:51:04.

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92 Functional Behavioral Assessment, Diagnosis, and Treatment

This chapter presents a function-based diagnostic classification system for target problem behaviors: The Cipani Behavioral Classification System (BCS). There are four major categories in this system, previously delineated in this text in Chapter 1 and historically (Cipani, 1990, 1994; Cipani & Cipani, 2017; Cipani & Schock, 2007, 2011). These are: (a) Direct Access (DA) 1.0, (b) Socially Mediated Access (SMA) 2.0, (c) Direct Escape (DE) 1.0, and (d) Socially Mediated Escape (SME) 4.0. The Cipani BCS delineates 13 different classifications of behavioral functions under these four major functional classification categories. Each of the 13 individual categories contain either a different behavioral function under a specified establishing operation and/or a different manner in which such a function is produced (direct vs. socially mediated).

The Cipani BCS is a classification system for behavioral functions; it does not categorize forms of behavior or “symptoms.” How is a function-based BCS differ from a more traditional classification system for problem behaviors? The following section identifies the basic characteristics of a function-based classification system.

WHAT IS A FUNCTION-BASED CLASSIFICATION SYSTEM? The characteristics of a function-based diagnostic classification system are the following (Cipani, 1994):

ll Diagnosis of behavior problem characteristics, not child characteristics ll Prescriptive differential treatment derived from a differential diagnosis ll Assessment data collected provides information on context variables, not just rate of

behavior ll Assessment phase concludes with diagnosis phase, in which a function-based category

is selected that best fits the problem behavior’s putative function under the specific EO

Diagnose Behavior, Not Client A function-based diagnostic classification system examines the contextual nature of the problem behavior. It does not presume that the exhibition of behavior is driven by characteristics inherent in the client or child. This sharply contrasts with the current psychiatric approach to diagnosing client behavior (e.g., Diagnostic and Statistical Manual of Mental Disorders [5th ed.; DSM-5]). In a function-based diagnostic classification system, the form of the behavior (in many cases) does not dictate a particular function.

Let us say you have three different children with whom you are involved as a behavioral consultant. Each child engages in a topographically (form) different set of target behaviors. In the traditional psychiatric diagnostic system, each child may receive a different diagnosis because the form of the problem behaviors is different. Because the behaviors or symptoms are different, their presumed cause is assumed to be different. In contrast, a function-based classification of the problem behaviors may reveal that the problem behaviors exhibited by these three children are similar in function, even though topographically dissimilar. Therefore, the classification of these behaviors function using the Cipani BCS could be the same. Using this hypothetical example, let us presume that the functional behavioral assessment obtained data that indicates that all three children’s behavior produces the same reinforcer (i.e., access to tangible reinforcers such as preferred activities). Hence, the function-based diagnosis for all three sets of problems might be subsumed in the same major category. Therefore, despite the obvious individual differences between these children, the prescription for behavior- analytic treatment for this problem area will be similar in composition.

Prescriptive Differential Treatment As just alluded to, a function-based diagnostic classification system also has implications for differential prescriptive treatment. The behavioral intervention designed takes into consideration the function of the problem behavior(s). It is the case that different topographies

Cipani, E. P. (2017). Functional behavioral assessment, diagnosis, and treatment, third edition : a complete system for education and mental health settings. Retrieved from http://ebookcentral.proquest.com Created from snhu-ebooks on 2018-10-18 20:51:04.

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3 The Cipani Behavioral Classification System 93

of behavior displayed by a given client can produce the same behavioral contingency if their function is the same. Here is an example.

A child diagnosed with a DSM-5 criteria of Oppositional Defiant Disorder is referred for a number of behavior problems. These problem behaviors include aggressive behavior toward residential staff, noncompliance, and running away from the facility. Aggression, noncompliance, and running away are topographically dissimilar behaviors. Does that mean that different behavioral contingencies should be invoked, depending on which behavior is exhibited at a particular time? Not in the least! If all three behaviors are found to serve the same environmental function, the treatment program would specify the same contingency across the occurrence of any of these behaviors. In other words, irrespective of which behavior occurs, the contingency it would produce (according to the functional treatment plan) would be the same. However, if noncompliance and running away serve a different function than the child’s aggressive behavior, there would be one treatment contingency for aggression and a different contingency for the other behaviors. The specifics of the behavioral treatment are driven by the function of behavior, not by the traditional diagnosis (such is actually irrelevant for functional treatment).

The same behavioral intervention would also apply if different clients or students engage in different forms of problem behaviors, but such behaviors serve the same function. Here is an illustrative example. A child named Susanna, diagnosed with conduct disorder, hits the teacher. A different child named Billy, diagnosed with oppositional defiant disorder, throws a tantrum during class and refuses to follow even simple directions. A third child, Raul, who is diagnosed with attention deficit hyperactivity disorder (ADHD), cries and throws a tantrum when he is prevented from running out of the classroom. Professionals who use a traditional diagnostic classification system presume that each of these three children exhibit different types of behaviors because of their different diagnostic classification. Susanna hits her teacher (and others) because of her affliction with conduct disorders. Billy throws a tantrum because he has oppositional defiant disorder. Raul cries and throws a tantrum because he is impulsive and is incapable of delaying gratification because of his ADHD. If there are three different disorders, should there not be three different treatments, that is, one for ADHD, one for conduct disorders, and so on? Our answer: Not if the different types of behaviors serve the same function (Cipani, 2014)!

Let us say that Raul’s tantrum behaviors and Susanna’s hitting behavior occur when they are denied access to a preferred activity. Both problem behaviors often result in getting the desired activity for each child. Given the same function, the behavioral treatment would be the same. If Billy’s topographically dissimilar problem behaviors are found to produce escape from the task, then the treatment would be designed that addresses that function. But it would be different because of the different function involved (i.e., access vs. escape), not the hypothesized mental disorder! Research studies in applied behavior analysis have failed to demonstrate that certain behavioral procedures work only for children with conduct disorder, or oppositional defiant disorder, and not for those with ADHD, and vice versa.1

In summary, classifying problem behaviors according to environmental function does make a crucial difference in the design of a functional behavioral treatment. In contrast, differential diagnosis using the traditional psychiatric Diagnostic and Statistical Manual of Mental Disorders does not prove fruitful in determining functional behavioral treatments based on syndromes of behaviors.

Assess Context Variables It should now be clear that a useful Functional Behavioral Assessment is concerned with more than just determining the rate of the target behavior. Assessment is driven by the need to determine the environmental factors that are present when the problem behavior occurs, that is, the social and physical environmental context. The effects of both antecedent and consequent conditions of the problem behavior need to be considered. Understanding the role of the client’s antecedent motivational condition at the time makes for a clearer picture of why certain consequent events function as reinforcers at those times. Understanding how certain people may be discriminative for such functions is also important (i.e., socially mediated functions).

Cipani, E. P. (2017). Functional behavioral assessment, diagnosis, and treatment, third edition : a complete system for education and mental health settings. Retrieved from http://ebookcentral.proquest.com Created from snhu-ebooks on 2018-10-18 20:51:04.

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94 Functional Behavioral Assessment, Diagnosis, and Treatment

Assessment Phase Concludes With a Differential Diagnosis Phase In the early development of the field of applied behavior analysis, the design of behavioral treatments often did not include a diagnostic phase. The collection of behavioral data often would lead directly to the formulation of a behavioral treatment regimen. In part, this occurred because the word diagnosis was associated with the mental health diagnostic system, which proved useless in the design of behavioral treatments. Given the lack of utility of a traditional diagnosis in prescribing functional behavioral treatments, many early behavior therapists/ behavior analysts have often worked with only two stages of service (i.e., assessment phase and subsequent design of treatment).

We believe that the Cipani BCS serves an important intermediate step. Such an intermediate phase between assessment and intervention would provide for a more guided and deliberate approach to behavioral treatment selection.

WHAT IS THE UTILITY OF A FUNCTION-BASED DIAGNOSTIC CLASSIFICATION SYSTEM? For people naive to behavior-analytic formulations, it may appear that one simply identifies a consequence for a selected target behavior. The selected consequence should be capable of ameliorating the level of the target behavior problem when applied as a contingency. Therefore, the only technical skill needed is to pinpoint the referred problem in observable terms and follow it with an effective consequence. For example, if a referred client is disruptive in an enclave-work environment, first one defines the disruptive behavior in observable terms. Then the professional identifies a consequence to follow the target behavior and specifies the treatment contingency. If this contingency does not work, the professional would select another consequence and design another behavioral treatment contingency.

GOT CONTEXT DATA?

I was involved in a case consultation years ago where a student who was attending a nonpublic school for emotionally disturbed children was being discussed at an interdisciplinary team meeting. Both school and mental health professionals were in attendance at this meeting. Although no actual behavioral assessment data were reported on specific target behaviors, the school and residential staff indicated that his behavior had worsened. They ascribed it to a litany of possible reasons. The reasons ranged from wrong diagnosis (e.g., “I don’t believe he is schizophrenic. I think he is bipolar!”) to blaming his dysfunctional family and his home visits. About 45 minutes went by without any pertinent discussion about specific target behaviors in the classroom. As the meeting was winding down, one of the teachers asked, “OK, what do we do when he acts up?” Somebody volunteered what appeared to be a solution, “Let’s use time-out.” Why was time- out being recommended? Was it important to comprehend that he was from a dysfunctional family, according to some experts? Are students who come from dysfunctional families best treated with time-out? Was it because time-out works best with manic-depressive children (but not, apparently, schizophrenia)? Nothing in the prior discussion had any relation to discussing the behavioral reasons for this proposed treatment. Nor was the rate of target behaviors presented. What was also missing was an analysis of the context under which these target behaviors occur. Further assessment of the contextual nature of the behavioral problems was required.

Cipani, E. P. (2017). Functional behavioral assessment, diagnosis, and treatment, third edition : a complete system for education and mental health settings. Retrieved from http://ebookcentral.proquest.com Created from snhu-ebooks on 2018-10-18 20:51:04.

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3 The Cipani Behavioral Classification System 95

Functional behavior-analytic treatment stems from hypotheses about the function or purpose of the target behavior. These hypotheses (classifications or categories of function) are generated from the collection and examination of functional behavioral assessment data. A function-based diagnostic classification of the problem behavior results from the clinician reviewing the information gathered during the functional behavioral assessment process. Such a process is analogous to procedures used in other science-based fields.

For example, in medicine, during an office visit, the physician gathers information about your current medical condition by asking you a series of questions, called a “diagnostic interview.” She or he then obtains other information, possibly from a physical examination as well as individual tests run on medical equipment. The physician then analyzes all the data obtained relevant to your condition and hypothesizes about the cause of your current medical problem. The physician then makes a differential diagnosis. This diagnosis subsequently allows the physician to prescribe a treatment based on that diagnosis. This treatment prescription makes “good sense” given this diagnosis. The treatment for a diagnosis of flu is different from a treatment prescription for a diagnosis of whooping cough. We believe it is just as important in many circumstances to determine the function of the problem behavior to ensure that the behavioral treatment being prescribed is functionally related to the problem behavior.

The remaining text in this chapter will delineate the 13 functions in the Cipani BCS (see Table 3.1) and provide examples of each classification function. For diagnostic criteria for each of these classification categories for use in school settings, the reader is enjoined to read Cipani and Cipani’s (2017) diagnostic manual for the Cipani BCS.

THE CIPANI BCS Cipani (1990, 1994) previously delineated four major diagnostic categories for classifying the environmental function of problem behaviors. The previous editions of this text utilized the same framework in the delineation of the function-based classification system (Cipani & Schock, 2007, 2011).

The following major category functions constitute this classification system:

(1.0) Direct Access (2.0) Socially Mediated Access (3.0) Direct Escape (4.0) Socially Mediated Escape

Within each major category, subcategories are offered. Each subcategory contains the basic characteristics inherent in the major category. The subcategories within each major category are:

ll DA 1.0 Functions l° DA 1.1: Immediate Sensory Stimuli (specify type and location of stimulation) l° DA 1.2: Tangible Reinforcers (specify tangible or class of tangible accessed)

ll SMA 2.0 Functions l° SMA 2.1: Adult Attention (specify which adults/staff) l° SMA 2.2: Peer Attention (specify which peers) l° SMA 2.3: Tangible Reinforcers (specify tangible or class of tangible accessed)

ll DE 3.0 Functions l° DE 3.1: Unpleasant Social Situations (specify situation[s]) l° DE 3.2: Lengthy Tasks/Chores/Assignments (specify length of task) l° DE 3.3: Difficult Tasks/Chores/Assignments (specify task that is difficult) l° DE 3.4: Aversive Physical Stimuli/Event (specify aversive physical stimulus)

Cipani, E. P. (2017). Functional behavioral assessment, diagnosis, and treatment, third edition : a complete system for education and mental health settings. Retrieved from http://ebookcentral.proquest.com Created from snhu-ebooks on 2018-10-18 20:51:04.

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96 Functional Behavioral Assessment, Diagnosis, and Treatment

ll SME 4.0 functions l° SME 4.1: Unpleasant Social Situations (specify situation[s]) l° SME 4.2: Lengthy Tasks/Chores/Assignments (specify length of task) l° SME 4.3: Difficult Tasks/Chores/Assignments (specify task that is difficult) l° SME 4.4: Aversive Physical Stimuli/Event (specify aversive physical stimulus)

Category: DA 1.0 Given a deprivation EO, the abolishing operation (i.e., delivery of positive reinforcer) occurs directly through the problem behavior or at the end of a chain of behaviors. In much of the professional literature, this category of behaviors has been referred to as automatic reinforcement (Vaughn & Michael, 1982). Our approach is slightly different from the currently in vogue use of the term automatic reinforcement. The use of the term direct access (and the latter term, direct escape) removes some of the possible misinterpretation of the term automatic. It borrows such terminology from Skinner’s verbal behavioral writings in describing verbal and nonverbal behavior (Skinner, 1957; Vargas, 1988).

We believe there is an advantage to the use of the term direct, in contrast to automatic reinforcement. Using the term direct is defined as behavior that contacts the nonsocial contingency (i.e., physical environment) directly, within a 0.5-second time interval. In other words, the reinforcing event occurs within 0.5 second of the terminal response occurring. If a behavior is maintained by an event that occurs subsequent to this time frame, it is probably not in this category. Further, not all DA functions involve stereotypic behaviors that produce sensory reinforcement as the maintaining contingency (see subcategory 1.2).

There are two subcategories serving DA functions: DA 1.1 Immediate Sensory Stimuli and DA 1.2 Tangible Reinforcers.

DA 1.1: Immediate Sensory Stimuli. Probably one of the greatest advancements in treating difficult problem behaviors exhibited by persons with severe disabilities, such as stereotypic behavior, is the understanding and demonstration that such behaviors may not be socially mediated (Caudery, Iwata, & Pace, 1990; Iwata, Dorsey, Slifer, Bauman, & Richman, 1982; Mason & Iwata, 1990). Problem behaviors in this category produce immediately (often within 0.5 second of terminal response) the sensory event that maintains such behavior. For example, persons who engage in frequent repetitive movements such as hand flapping often do so because of the sensory result such repetitive behaviors produce. Flapping their hands in a certain fashion produces a kinesthetic result that automatically creates its own built-in reinforcer.

Here is another example. Try rocking back and forth in a chair, and note the rhythm produced. Such a chain of behaviors produces a built-in sensory event. This built-in event can function as a reinforcer for the “rocking in the chair” behavior. Such an automatically produced result becomes more desired by persons who cannot create many forms of sensory stimulation due to their cognitive impairments. In contrast, nonhandicapped people are able

TABLE 3.1 n ANALYSIS OF DIRECT ACCESS FUNCTIONS: STEREOTYPIC BEHAVIOR

Establishing Operation (EO)

Behavior Abolishing Operation (direct)

Future Probability of Behavior Given EO

Relative deprivation of sensory event

Engages in specific stereotypic behavior

Produced immediately, reduces deprivation state

More likely

Cipani, E. P. (2017). Functional behavioral assessment, diagnosis, and treatment, third edition : a complete system for education and mental health settings. Retrieved from http://ebookcentral.proquest.com Created from snhu-ebooks on 2018-10-18 20:51:04.

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3 The Cipani Behavioral Classification System 97

to watch TV, read a book, listen to music, go on swings, and engage in other solitary activities on occasion. But for nonhandicaped people, occasionally engaging in such activities does not consume one’s entire purpose for the day. However, for persons with disabilities, such stereotypic behavior pervades the entire day and conflicts with alternate essential daily activities and behaviors.

Table DE 3.1 depicts the relationship between the sensory event being in a relative deprivation state (see first column A, Establishing Operation) and the occurrence of the self-stimulatory behavior (second column). Note that the maintaining contingency or abolishing operation is the direct result the behavior produces (third column). Any effect of the behavior on the social environment is inconsequential. The staff or teacher may admonish the client or child after the behavior. However, such a social event is not the purpose of this behavior, even though it may be a reliable contingency of the behavior. It is the sensory result of the stereotypic behavior that will make such a form of behavior occur again when a sufficient state of deprivation is present. Sensory events that can be produced directly through various behaviors can include auditory, visual, tactile, gustatory, and olfactory stimuli.

Many ritualistic (stereotypic) behaviors appear to produce their own immediate kinesthetic reinforcer. Such behaviors often occur independent of the reaction from the social environment. Addictive behaviors, such as smoking and drinking, may also be maintained as a result of their immediate sensory effect. Although this may not describe how such behaviors were developed in the first place, it can explain why such behaviors are still maintained even when the original purpose (EO) is no longer operable. Certainly, for smokers at certain age ranges, social reinforcement and peer acceptance of smoking has diminished tremendously in the last several decades. Yet some people continue to smoke despite the absence of peer reinforcement (and known health risks). Why? For smokers who began the habit years ago, the act of smoking often has its own built-in reinforcer. Table 3.2 provides some questions to consider when entertaining DA to immediate sensory stimuli as a hypothesis.

In Question 1, you should consider whether a one-to-one relationship exists between the behavior and the sensory event. What is the desired sensory event (Question 2)? In some cases, it may be easy to determine the probable sensory reinforcer. For example, someone who sings in the shower is probably reinforced with the auditory result of vocal production in an enclosed area. However, in other cases, it may be difficult to discern what automatic sensory event is the reinforcer. If necessary, an experimental analysis that presents conditions where the sensory effect is ameliorated or eliminated may be the most effective manner of determining such.

www.springerpub.com/fbadt

SMA or DA lecture

ASSIGNMENT

After reviewing the narrated PowerPoint lecture entitled, “Is It SMA or DA?” delineate the test procedures that can be used to isolate the function of behav- iors that appear to be DA, but could also be SMA functions.

For the select target behavior of hair twirling, include in your paper the fol- lowing (in this order):

1. Delineate the procedures for the test condition involving DA function (behavior that produces what contingency).

2. Delineate the procedures for the test condition involving SMA function (behavior that produces what contingency).

3. Generate hypothetical data in a table or graph that displays data for three session for each test condition (six total sessions) in a multielement design, Then explain in text what the results indicate, that is, what function seems verified by the hypothetical data.

Cipani, E. P. (2017). Functional behavioral assessment, diagnosis, and treatment, third edition : a complete system for education and mental health settings. Retrieved from http://ebookcentral.proquest.com Created from snhu-ebooks on 2018-10-18 20:51:04.

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http://www.springerpub.com/fbadt
98 Functional Behavioral Assessment, Diagnosis, and Treatment

Question 3 addresses the evidence that points to a hypothesis of DA to sensory reinforcement. If the problem behavior is sensory reinforced, it will often occur across most contexts (possibly excluding contexts where punishing consequences have affected the rate). For many clients who engage in self-stimulatory behavior, they engage in such behaviors irrespective of context. If a client engaged in hand flapping only in the context of certain staff, and not others, such a pattern of stereotypic behavior would seem to point to an SMA function. Perhaps some examples of subcategory DA 1.1: Immediate Sensory Stimuli will clarify DA functions representative of this category.

Talking Is Good? I observed a client at a residential facility for persons with disabilities talking loudly to herself while pushing a laundry cart across a parking lot. I looked around and did not see any staff or other people. How can anyone talk or engage in conversation when there is not an audience with which to interact? A traditionally trained mental health professional may surmise that such vocal behavior is directed at an imaginary person. They contend that the client is carrying on a conversation with someone in her mind, who is responding back to her. Although one cannot see what is transpiring inside her cortex, these professionals assume the existence of such on the basis of the carried on conversation. Hence, the client might be hypothesized to be experiencing auditory hallucinations during those incidents.

Is there an alternate explanation? Can such a behavior be maintained in the absence of an audience? Vocal discourse may produce its own reinforcer, that is, auditory (hearing one’s voice) or kinesthetic effect on vocal cords. Certainly, this phenomenon is present in infants who babble for long periods, testing out their newfound ability to generate a sensory effect by vocal production. As I observed this person pushing the laundry cart by herself, that certainly seemed a plausible hypothesis.

How can one determine whether sensory reinforcement is maintaining the client’s vocal behavior? If this behavior occurs when staff are not physically present, and such behavior does not result in their subsequent attention, its function does not seem to be socially mediated. In contrast, if particular staff attend to her in certain ways upon hearing her talking to herself, then subcategory DA 1.1 is probably not an accurate diagnosis for this client. Further evidence of a socially mediated function would be the inability of other behaviors that are in the client’s repertoire to get staff or adult attention when it is available.

Failure to diagnose this as a behavior maintained by sensory reinforcement when indicated may lead to the design of an ineffective treatment strategy. If the vocal discourse produces a DA function, a treatment strategy that involved “ignoring the behavior” would have no effect at all on the rate of this behavior. Intervention of problem behaviors within this category should be aimed at “weaning her off ” of sensory reinforcement or bringing it under control in certain contexts that are not as public (see Chapter 4).

The Voices Make Me Laugh. Here is a similar real-life circumstance. A man, for no apparent reason, would occasionally just burst out laughing as if he had just heard the funniest joke in the world. During an intake at a psychiatric center, he told the professional conducting the assessment that he heard voices in his head. These voices would tell him

TABLE 3.2 n QUESTIONS TO CONSIDER

1. Is there a reliable (every single occurrence) relation between the specific behavior and immediate production of the hypothesized desired sensory event? What is the specific form of the behavior?

2. What seems to be the auditory, visual, tactile, kinesthetic, or gustatory sensation that maintains contingency?

3. What evidence supports the hypothesis that a sensory event is the maintaining contingency? Does this behavior occur across a variety of situations when the client is in a deprived state relative to the sensory event? In other words, does the client engage in this behavior (usually) irrespective of context? Will it occur in the absence of people?

Cipani, E. P. (2017). Functional behavioral assessment, diagnosis, and treatment, third edition : a complete system for education and mental health settings. Retrieved from http://ebookcentral.proquest.com Created from snhu-ebooks on 2018-10-18 20:51:04.