Functional behavioral assessment diagnosis and treatment 2nd edition pdf

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1Basic Concepts and Principles Objectives

• Students will be able to describe and provide an illustration of a direct access function

• Students will be able to describe and provide an illustration of a direct escape function

• Students will be able to describe and provide an illustration of a socially mediated access function

• Students will be able to describe and provide an illustration of a socially mediated escape function

• Students will be able to identify an establishing operation for a number of access functions as one of a state of deprivation

• Students will be able to identify an establishing operation for a number of escape functions as one of a presenting state of aversion

• Students will be able to discuss what a contrived contingency is and how it can “override” existing motivational variables

Chapter 1 Behavior Analysis Certification Board (BACB) Task List

4th edition 5th edition • FK-01 Lawfulness of behavior

• G-04 Explain behavioral concepts using nontechnical language

• E-01 Use interventions based on manipulation of antecedents, such as motivating operations and discriminative stimuli

• B-4 Define and provide examples of positive and negative reinforcement contingencies.

• B-5 Define and provide examples of schedules of reinforcement.

• B-6 Define and provide examples of positive and negative punishment contingencies.

• B-7 Define and provide examples of automatic and socially mediated contingencies.

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 2018-10-02 19:29:19.

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2 Functional Behavioral Assessment, Diagnosis, and Treatment

WHY DOES HE DO THAT? Why does he do that? This is the age-old question that people ask when they see a child throw a fit in public. Why does he behave like that? To date, an often-cited explanation of such undesirable behavior involves a hypothesis about the brain’s development in the child who is “afflicted” with such behavior. The underpinning of the undesirable tantrum behavior is hypothesized to be the result of some abnormality or underdevelopment of some part or parts of the brain. As further evidence of brain involvement, in some cases, such behavior along with other behaviors form the basis of a mental disorder. Following is an excerpt from a hypothetical lecture in a child psychology class.

Student: Dr. Trait, I have a question. Why do some children have tantrums that are clearly inappropriate for their age?

Dr. Trait: The child throws the tantrum because he or she is immature for his or her age; the brain has not fully developed. Once the brain matures—particularly the frontal lobe, which is responsible for executive functioning—the child will not respond to social situations in that manner. Until that point, we can expect this child to continue behaving in such a fashion because of his or her inability to process events adequately. Teenagers have a similar problem with brain immaturity when they behave impulsively. Their brain is not like the adult brain; hence, they too cannot be fully responsible for their impulsivity.

Variations and extensions of this immature brain explanation exist. The following is a continuation of this conversation in a class in developmental psychology, with a slightly different explanation.

Student: In Dr. Trait’s class, we were told that children who have severe tantrums that are clearly inappropriate for their age do so because their brain is not fully developed. Is there any experimental cause-and-effect evidence for such an assertion?

Dr. Stager: Well, I believe there is more to it than just the brain’s development, although I would concur that neurological issues are part of the problem. Children behave in a certain manner because they have not proceeded through certain invariant developmental stages. I would say that these children have not progressed past the egocentric stage. Of course, once the brain has developed, it is more likely that these children will interpret the actions of others as reasonable and not view everything from a “me first” perspective. When this happens, these children will not react in such a manner, but will respond to conflict in a more age-appropriate way.

Suppose we believe that the child throws a tantrum because the brain is not yet fully developed. What are the ramifications of dealing with such behavior when the supposed cause is brain malfunction? Do we wait until the brain becomes more fully developed? For clients who have continued such “immature” behaviors throughout their adolescence and into adulthood, do we still continue to wait? What can be done in the interim to reduce the child’s tantrums and develop a more acceptable manner of dealing with his or her social environment?

What is wrong with these interpretations about tantrum behavior? The role of the environmental response to such behavior is trivialized. If the brain has not developed, apparently what people do in response to the child’s behavior, whatever the form, is insignificant and, therefore, irrelevant. One can only hope that the child’s brain becomes more fully developed. We believe there is a better conceptualization of why tantrum behavior occurs.

Instead of saying that the child throws a tantrum because he or she is immature, we would possibly ascribe such an incident to the purpose or function such tantrum behavior serves in that child’s environment. That conceptualization would generate an examination of observable events in the social environment. In the case of a child’s tantrum behavior, one would examine what the social environment does when the child has a fit in public. What is the antecedent context for such tantrum behavior? How does the social environment

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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 2018-10-02 19:29:19.

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1 Basic Concepts and Principles 3

react to these tantrums in the short and long term? This examination of temporally ordered environmental events can reveal the purpose of this behavior in this context.

This approach is termed a functional behavior-analytic approach to understanding human behavior (Bailey & Pyles, 1989; Cipani, 1990; Cipani & Trotter, 1990; Iwata, Vollmer, & Zarcone, 1990; LaVigna, Willis, & Donnellan, 1989; Lennox & Miltenberger, 1989). In a functional behavior-analytic approach, all operant behavior is viewed as serving an environmental function, either to access something or to terminate/avoid something (not withstanding genetic influences for some behaviors). Although other psychological explanations invoke hypothesized traits or developmental stages to explain behavior, a functional behavior-analytic viewpoint examines the roles of both the social and physical context—it deals with events that are both observable and measurable.

A hypothetical 7-year-old child named Oskar, diagnosed with oppositional defiant disorder (see the Diagnostic and Statistical Manual of Mental Disorders [5th ed.]; DSM-5), has extreme oppositional behavior with occasional aggressive behavior. Explaining such behavior as a result of his disorder is sufficient for many mental health professionals. When asked why this child has such episodes, their response would be: “It is a symptom of his underlying disorder—oppositional defiant disorder. He behaves in an extreme fashion because he has this disorder.” As you can see, this is a trial lawyer’s dream. People do things because they have a disorder. If they have this disorder, they cannot help it.

Whenever this form of behavioral episode occurs, it is the disorder that made him do it and he will engage in such behavior from time to time. It further presumes that such a behavior will occur irrespective of context and consequences. The child engaged in the defiant and/or aggressive behavior because of his malfunctioning brain. Such brain malfunctions are not predicated on the presence of any environmental context. One never knows when the neurons misfire; when they misfire, defiant and aggressive behavior results.

In contrast, a functional behavior-analytic view would explain such behavior more from the social (and sometimes physical) context of the behavior. One would examine Oskar’s history of oppositional and aggressive behavior and how such behavior alters his existing social environment. An understanding of why the behavior occurs is accomplished through an analysis of the behavior’s ability to either produce desired events or terminate undesirable events.

For example, we may discover that Oskar often engages in such behavior when he comes home from school. Oskar’s mother wants him to stay in the house for a while and either do his homework or finish cleaning his room. Oskar, of course, wants to go outside and play with his friends. He sometimes will complain and whine. His mother will respond to such complaining with the following retort: “You need to finish your homework. How do

WHY IS TRADITIONAL COUNSELING OFTEN NOT EFFECTIVE WITH MANY CHILDREN WITH SEVERE PROBLEM BEHAVIORS?

In 2016 many people believe that sending children with severe problem behaviors to counseling is the best method for changing these behaviors. Can anyone (through counseling) convince Oskar that aggressive behavior is not in his best interest? What is in a child’s best short-term interest when he is placed in time-out? It is getting out of time- out. As a reader of these materials, do you believe that talking to Oskar once or twice a week will convince him not to behave aggressively toward his mother when he is told he cannot go outside?

How will Oskar’s behavior change? Ultimately, it is up to the care providers and parents to change their own behavior in order to change the child’s behavior. If Oskar’s mother continues to handle this situation in the same manner, I cannot see where anyone can convince him to respect his mother’s wishes and do his homework before going outside. In a functional behavioral-analytic approach, the presenting problem is not just with the child. It is also with the way the child’s environment responds to his behavior.

You change child behavior by changing the behavior of the adults who deal with that child. Pure and simple!

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 2018-10-02 19:29:19.

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4 Functional Behavioral Assessment, Diagnosis, and Treatment

you expect to pass third grade? Once you are done with your homework, then you can go outside.” This parental response to his behavior incurs more arguing and defiance from him, with refutations for each assertion by his mother. When Oskar sees that this verbal battle with his mother is not helping his cause (i.e., getting to go outside), he tries another tact. He states, “I’m going to leave and you can’t stop me.” When he begins to exit the house, she grabs him. At this point, he yells at her, calls her names, and hits her. After a struggle, Oskar pulls away and heads out the door. His mother, tired of fighting with her son, lets him go, complaining he is just like his father.

With this information, what is a more plausible explanation for Oskar’s behavior during these circumstances? Does he act out because he is disordered? Or does the explanation lie in an understanding of how such a behavior impacts his environment? Does less intense arguing with his mother result in him going outside? Or does he get to go outside when he becomes assertive (walking to the door) and combative (when he hits his mother as she tries to get him to stay inside)? What is the best explanation for Oskar’s aggressive behavior in the afternoon? He does it because it “works” for him when he wants to go outside, and other behaviors such as complaining are less effective. The function of such combative and aggressive behavior provides an explanation of why it occurs. Such an explanation can be experimentally demonstrated, as you will find out in the coming pages of this book.

THE CORNERSTONE FOR UNDERSTANDING WHY In a functional behavior-analytic approach, behavior is viewed as functional (i.e., purpose- ful) for certain antecedent contexts because of the contingency or contingencies involved. Simply stated, behavior always makes sense, from the standpoint of the person exhibiting such behavior. A contingency is the temporal relationship between behavior and a consequence. It is often stated as an “if, then” rule. If you get an A on your quiz, then I will take you out for ice cream. If you stick your hand in the door and it closes on your hand, then you will experience pain and yell loudly. Such social and environmental consequences influence whether the behavior that produces them will become more or less probable in the same or similar context.

For example, the manner in which Oskar’s mother responds to his mild complaining behavior makes that behavior ineffective. If Oskar wants to go out, and he complains, it seems that such behavior is not instrumental in getting him outside in the immediate future. Therefore, mild pleading and complaining behavior becomes less likely in subsequent afternoons when Oskar wants to go outside. The current arrangement between complaining and not getting to go outside makes such forms of complaining a less viable alternative in these circumstances.

However, the story for verbal defiance and physical aggression is quite the opposite. These behaviors, including defying her wish to stay inside by physically leaving, are functional in accessing the desired event. The next day, when Oskar’s request to go outside is denied, what would he likely do? You guessed it. If Oskar’s mother continues to respond to her son’s defiance and aggression in the same manner, such behaviors become functional in that context. If this relationship between aggressive behavior and going outside becomes strengthened, under certain motivating and antecedent conditions, then such a relationship defines a maintaining contingency or behavioral function. There are two major types of behavioral functions for problem (or other) behavior: positive reinforcement and negative reinforcement.

BEHAVIORAL FUNCTIONS INVOLVING POSITIVE REINFORCEMENT (ACCESS FUNCTIONS) Positive reinforcement functions involve behaviors that produce an environmental event that subsequently increases the likelihood of that behavior under the same or similar antecedent motivating conditions. In other words, the operation of positive reinforcement involves

Why does he do that!

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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 2018-10-02 19:29:19.

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1 Basic Concepts and Principles 5

a behavior that produces an event (activity, object) that subsequently strengthens the occurrence of that behavior in the future (under certain motivational contexts). As a result of such a behavior-contingency relationship, the behavior becomes functional under given motivating conditions (to be discussed in greater detail later in this chapter). For purposes of the function-based diagnostic system delineated in Chapter 3, positive reinforcement functions are termed access functions, that is, these behaviors access preferred items, events, or activities.

What are some hypothetical illustrations of access (positive reinforcement) functions? Milton, an inpatient client with schizophrenia, is reported to frequently pinch other clients. Is this pinching behavior the result of his schizophrenia? Is it the result of his inability to control his impulses? I believe neither explanation would serve a useful or parsimonious purpose. After some duration and frequency (to be explained in Chapter 2), when Milton pinches others we find that staff take him for a walk. Their rationale for such a response to his pinching is that they want to get him away from other clients. They report that Milton seems to be less anxious when he is on his walk and that the walk calms him down. Facility staff, thereby, interpret their use of a walk as an “anxiety-reductive procedure” and believe that this practice is clinically sound. However, what escapes them is the long-term result of this reliable contingency between what Milton does and what they do. Milton has learned how to get a walk with staff—pinch someone! We would say that pinching other people is a functional behavior when Milton desires a walk. Unfortunately, other more appropriate behaviors do not appear to be more effective (i.e., less functional) in getting a walk. The behavior of pinching others subsequently increases to a level that constitutes a major problem, which now jeopardizes Milton’s ability to remain in the current inpatient unit.

Bea, a residential adult female client, throws a tantrum (consisting of screaming and slapping herself) at certain times during the day. Bea’s tantrum behaviors are reported to consist of yelling, hitting or slapping herself, calling staff profane names, claiming she was placed in this facility by the Mafia, and making verbal threatening statements to staff and other residents. When she engages in such behavior for a period of time, one can observe staff members give her something to eat. These staff members interpret her behavior, after some duration, as a sign that she is hungry. Of course, feeding her certainly stops the threats made to them and others. Although feeding Bea may produce the desired short-term result, it creates long-term disaster. Such tantrum behaviors become more probable for Bea when she is relatively hungry (or at least when she wants certain food items). You might conclude that Bea’s tantrum behavior is maintained because it is capable of acquiring food when she is hungry. Bea may also learn to engage in the same type of tantrum behavior when she wants her CD player and is told she has to wait until after dinner for it. If such behavior reliably results in Bea getting the CD player before dinner, then tantrum behavior also becomes functional under the conditions of Bea desiring the CD player. We would expect an increase in the frequency of tantrum behavior across the next few weeks as it becomes strengthened as a functional behavior when she desires the CD player.

A 4-year-old child named Elvira, diagnosed with autism, will engage in screaming and hitting herself multiple times during the day. Many people will explain such behavior by referring to her developmental disorder. They will proclaim, “Elvira throws a tantrum because she has autism. Her autism is the cause of this behavior.” But is this really a good explanation? Can one predict that all children with autism will engage in such behaviors independent of social context? Does such behavior differentiate children with autism from children with other developmental and/or mental disorders (i.e., only children with autism hit themselves)? If such behavior is caused by autism, what options remain for the successful treatment of such behaviors, ameliorating or eliminating autism? Although eliminating or curing autism is certainly a laudable goal, is it reasonable to suspect that this will occur in time to help Elvira before she enters school? Before she becomes an adult?

A more productive and functional approach focuses on the environmental function (i.e., outcome) of problem behaviors. For Elvira, screaming might reliably access parental attention, or hugging, under conditions in which she desires such activities or events. When Elvira desires parental attention because it has been some time, tantrum behavior becomes

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 2018-10-02 19:29:19.

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6 Functional Behavioral Assessment, Diagnosis, and Treatment

more probable. The production of attention for some level and duration of tantrum behavior then maintains Elvira’s behavior as functional in accessing attention.

BEHAVIORAL FUNCTIONS INVOLVING NEGATIVE REINFORCEMENT (ESCAPE FUNCTIONS) Although many people are familiar with positive reinforcement, negative reinforcement is often misunderstood (Cipani, 1995; Cipani & Spooner, 1997; Iwata, 1987). An understanding of negative reinforcement operations is critical to the design of effective treatments, particularly if you serve individuals who often engage in behavior problems during task demands, compliance situations, instructional conditions, or chores and work tasks.

In negative reinforcement, the effect of the behavior is to terminate the existence of, or postpone (for some time), the presentation of a stimulus condition or event. Such an event is commonly referred to as aversive or unpleasant (relative to the individual). Realize that the term “aversive” is relative. What is aversive to one person may not be to another; what is aversive today may be less aversive next week. The subsequent effect of a negative reinforcement contingency on behavior is one of increasing its probability under the same or similar conditions in the future. Negative reinforcement functions are called escape functions (includes avoidance functions in this terminology).

Examples of escape functions with problem behavior can be used with the previous hypothetical cases by altering the behavioral effect of the problem behavior. For example, Bea is asked to clean up her room. She will often refuse such an initial request. When staff persons at the facility warn her that she will not get to watch television that night, she screams and yells at them. After an intense episode, Bea sometimes gets put in time-out and loses her television privileges. However, with certain staff persons, if she promises not to raise a commotion, the staff person will clean up Bea’s room for her so she can watch television. Such a behavioral effect subsequently increases the probability of Bea screaming in those conditions (or similar conditions) in the future.

Can pinching people occur for a different reason than wanting a walk? Let us say that Milton also pinches people when he is asked to go to group therapy (which he finds aversive). What is the “reason” or function for pinching when confronted with this request? Suppose the following events play out when Milton pinches a staff person when it is time to go to group therapy. When he pinches a staff person, someone decides that he should be taught that this is wrong. Milton should be put in time-out to teach him that pinching is inappropriate. The staff keep him in time-out until he is quiet and is able to say he is sorry for pinching the staff person. His apology does not occur readily and the minutes go by. By the time Milton is allowed to leave time-out, his group’s therapy hour is almost over. He therefore is able to shorten his participation in group therapy by going to time-out and being adamant about his right to pinch people. Unfortunately, Milton does not learn the “lesson” that the time-out was intended to teach, and instead it intensifies his pinching behavior before group therapy. One staff person remarks that it almost seems as if Milton pinches to avoid going to therapy, but others quickly dismiss such a contention.

As a result of this imposed time-out consequence for pinching, Milton is pinching more often when it is time to go to group therapy. Consequently, he misses most therapy sessions in a given week. Can you see why he is pinching when it is time to go to therapy? Pinching avoids an activity Milton dreads—going to group therapy. As a side note, it might be interesting in this case to find out why Milton does not like to go to group therapy (i.e., what does he wish to avoid) in order to solve this behavior problem in the long term. Beyond that, one might question why he should go to group therapy. If it was to help him uncover the reasons for his pinching mode of interaction, we could now dispense with such a requirement (given its obvious lack of effectiveness).

Another example illustrating a negative reinforcement function is the self-abusive behavior of a child with autism spectrum disorder (ASD). As a general note, very often

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 2018-10-02 19:29:19.

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1 Basic Concepts and Principles 7

in classroom situations, problem behaviors such as self-abuse can often function to avoid or terminate instruction. Hence, under such conditions certain behaviors become very “adaptive.” This child hits his or her head with an open hand or closed fist, and such behavior often seems to occur during group instruction. Consequently, the teacher will often stop instruction or remove the child to deal with the self-abuse. Self-abuse becomes functional in lessening or avoiding such a context.

Unfortunately, self-abuse is often unintentionally exacerbated. If staff reason that the child hits him- or herself for their attention, they might conclude that ignoring this behavior will make it decrease and eventually disappear. When the function of this child’s self-abuse is misdiagnosed as attention seeking, ignoring minor forms leads to more disastrous forms of behavior. As a result of staff ignoring minor forms of self-abuse, the severity of the self- injury intensifies. The more severe head hits do result in the instruction being halted for a period of time. Consequently, more severe self-abuse becomes prevalent, as a result of its ability to effectively terminate instruction. Perhaps, at the beginning of the year, the teaching personnel reported to the individual education plan (IEP) team that this child does engage in self-abuse, but they can handle it. Of course, this was under the presumption that their ignoring strategy would work. Now, at mid-year, this child may no longer be suitable for this classroom because the self-injury has resulted in a broken nose and gashes on the forehead. The child may now require a placement where a more intensive behavioral approach is available. A minimal problem has developed into a major threat and hazard to this child’s health and educational welfare.

CONTRASTING ACCESS AND ESCAPE FUNCTIONS Table 1.1 provides more examples of behaviors that illustrate access (positive reinforcement) functions. Note that in all instances the effect of the reinforcement contingency is one that strengthens the behavior that produces the desired event. Table 1.2 illustrates how behaviors that previously accessed desired events now function to terminate aversive events. We conclude that the form of the client’s problem behavior does not usually give a clue as to behavioral function. Hence, a diagnostic system that focuses exclusively on symptoms to differentiate clients misses the mark.

Comparing Tables 1.1 and 1.2 provides an illustration of how the same behavior can produce different environmental effects, that is, consequences that maintain such behaviors.

www.springerpub.com/fbadtBA MODEL OF CHILDHOOD AGGRESSION Assignment: A Behavior-analytic model for explaining childhood aggression (see hot link in student portal; www.springerpub.com/FBAStudents)

After reviewing the lecture entitled, “A behavior-analytic model of childhood aggression,” submit a paper addressing the following questions in order:

• What is the behavior-analytic explanation for the possible etiology or cause of child aggression? How is that different from a traditional explanation? (See “Why Does He Do That?” section at beginning of chapter.)

• What is the behavior-analytic explanation for the continued display of child aggressive behavior over time?

• How do contrived punishment contingencies (adult-imposed) for aggressive behavior affect its function?

• Does watching or observing aggression explain the latter (i.e., how young children who are aggressive engage in such behavior when they are adolescents)?

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 2018-10-02 19:29:19.