SEARCH Day Program is a private, non-profit school in Ocean Township, New Jersey. Approximately 80 students, ages 3-21, are currently enrolled in the program. The school embraces research-based teaching strategies that are derived from applied behavior analysis while taking a multi-discipline approach to educating individuals with Autism. At the core of our program, we assure that our teaching procedures are assessment-driven and evidence-based, while our behavior interventions are safe, effective, respectful, and meaningful for the students we serve. In the spirit of these values, we introduced the interview-informed synthesized contingency analyses (IISCA) and subsequent skills-based treatments (Hanley et al., 2014) to the school setting in order to eliminate severe problem behavior.
Why We Sought Treatment
Individuals diagnosed with Autism may present core deficits such as impaired communication, difficulties in social interaction, and stereotypy (Centers for Disease Control and Prevention [CDC], 2020). Often associated with Autism, but not always core components, are dangerous problem behaviors such as aggression, self-injury or disruption. These problem behaviors can be described as “accidents of learning” in that the individual has added them to his or her repertoire over time as a means of coping or communicating. In our program, we recognized a number of students who routinely engaged in severe problem behavior, regardless of the collective efforts made by teachers, behavior analysts, and related services. We began to look for meaningful, safe, and effective treatments that targeted the cause of severe problem behavior (i.e., core deficits) as opposed to the symptom (i.e., problem behavior). We needed a function-based treatment that not only decreased problem behavior, but did so by teaching replacement skills in communication, tolerance and cooperation.
Although the traditional functional analysis (Iwata et al., 1982/1994) has long been considered the “gold standard” for determining the function(s) of behavior, its lack of compatibility with conditions outside of the clinical setting have made it largely unfeasible for many practitioners targeting the reduction of severe problem behavior. Until recently, there has been a lack of research showing the effects of function-based treatments implemented by ecologically relevant individuals in applied settings, such as teachers in schools (Santiago, Hanley, Moore, & Jin, 2016). In looking at the interview-informed synthesized contingency analyses (IISCA) and subsequent skills-based treatments (Hanley et al., 2014), we found a process that could be implemented by a board-certified behavior analyst (BCBA), classroom teacher, or therapist within the school setting.
The programs described in this article are the result of SEARCH’s ongoing consultation with Dr. Greg Hanley, PhD, BCBA-D, and Dr. Kelsey Ruppel, PhD, BCBA-D, of FTF Behavioral Consulting based in Worcester, Massachusetts. Dr. Hanley is a former editor of the Journal of Applied Behavior Analysis and his programs have been recognized by many in the field as effective in achieving safe and meaningful behavior change. Since April of 2019, the behavioral department at SEARCH has worked with Dr. Hanley and Dr. Ruppel in using the IISCA to develop skill-based treatment plans. Social validity is highly valued in Dr. Hanley’s programs and there is a strong emphasis on safety, rapport and the building of trust between students and staff.
Following a two-day on-site workshop with Dr. Hanley, we introduced a pilot program which included 4 students who routinely engaged in severe problem behaviors (i.e., aggression, self-injury, and property destruction). These behaviors often required crisis prevention intervention (CPI) to maintain the safety of the students and those around them. The students in the pilot program also had a long history of inconclusive functional behavior assessments (FBA). The resulting behavior intervention plans made use of arbitrary reinforcement while addressing hypothesized antecedents of problem behavior.
An open-ended interview was conducted with each student’s certified teacher. The interview allowed us to identify the topographies of problem behavior, specific materials, events, or interactions that often triggered problem behavior, and factors that were reported to stop problem behavior. For example, the interviewee was asked, “For a million dollars, what could you do to turn on problem behavior?” The answer to this question, along with the others, allowed the team to plan and create an analysis where materials and conditions could mimic those in the natural setting.
For each student, the IISCA was conducted in a designated classroom (“practice room”) and included a BCBA and a classroom teacher. The analysis was designed to evoke precursor behavior, which was identified to be sensitive to the same synthesized reinforcement contingencies as more dangerous problem behavior (Warner et al., 2020). The analyses demonstrated that establishing operations for problem behavior (EO) often included a synthesis of denial and delay, transitions away from preferred activities, and schoolwork demands (e.g., table top activities, reading and writing, etc.) For some students, the analysis also confirmed additional components of their EO synthesis included the presentation of words and phrases (aka “trigger words”) that had acquired aversive qualities (e.g., “slow down”). Previous research that suggested that multiple contingencies of reinforcement can control problem behavior (Ghaemmaghami et al., 2016) was supported by the analyses of the students in the pilot program. The synthesized reinforcement maintaining the problem behavior for each student included access to preferred items and activities, avoidance or escape from non-preferred activities, and the availability of the teacher to accommodate the student’s wants and needs.
Following the analysis, all four students were taught novel functional communicative responses (FCR) as a replacement to their problem behavior when presented with the EO, or non-preferred situation. The FCRs taught were low effort responses (non-specific omnibus mand) which immediately terminated the presentation of EO. The mode of communication was determined by the student’s vocal and gross motor capabilities. The FCRs were individualized for each student and included vocal phrases (e.g., “Can I have my way please”), hand gestures (e.g., four closed fingers with thumbs tapping chest) and augmentative devices (e.g., a “My Way” card connected to a retractable string attached to the student’s waist band). All four students were also taught denial and delay tolerance with three of the students using a tolerance response in vocal (e.g., “OK”) or non-vocal form (e.g., initiating a “high five”) after being told “no.” Additionally, all four students were systematically taught to tolerate engaging and cooperating in progressively longer chains of behavior during adult-led activities. There was a significant decrease in problem behavior during treatment (compared to functional analysis which served as baseline) for each student and the skills and tolerance were generalized to other people (e.g., teaching assistants, parents) and places (e.g., classroom) throughout the skill-based treatment.
Social validity measures were conducted through questionnaires in order to gather information regarding the level of safety experienced by staff and students. We also measured the acceptance level of the IISCA and treatment overall, and the satisfaction with both the level of behavior change and the training. The results indicated that classroom teachers and assistants found the process to be safe, appropriate and the outcomes to be meaningful. High social validity scores are indicative of a treatment that the participants found value in. Staff commitment to the process enabled us to achieve effective behavior change and greatly reduce severe problem behavior in our school.
The process of introducing the interview-informed synthesized contingency analyses (IISCA) and subsequent skills-based treatments (Hanley et al., 2014) has proven to be a rewarding, safe, and effective method of eliminating severe problem behavior. Through the treatment, students have acquired a variety of skills including those in communication, toleration, leisure, academic, independence, and life-skills.
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Centers for Disease Control and Prevention (2020). Diagnostic Criteria for 299.00 Autism Spectrum Disorder. www.cdc.gov/ncbddd/autism/hcp-dsm.html
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