Raluca- Maria Adam

Using FCT and Extinction as treatment for escape maintained

behavior for a child with autism

Abstract. This study examined the effects of a function based intervention, implemented with a boy, R.,
who had autism and attention deficit disorder. R. is not going to kindergarten, because his lack of
compliance, he had 4 hours of daily ABA therapy sessions in a therapy center. During his hours of
therapy, R. did not respond to demands, throwing himself on the ground and pushing away the therapist,
that’s why he couldn’t participate to kindergarten’s activities. Functional assessment data indicated that
R. throwing himself behavior was maintained by escape ( negative reinforcement). The data suggests
that R. can’t access such reinforcer using appropriate communication. A function based intervention
using functional communication training and extinction results in improvements in R’s behavior.
Introduction. Autism Spectrum Disorder (ASD) is defined in the Diagnostic and Statistical Manual of
Mental Disorders (5th edition; American Psyhiatric Association, 2013) as a condition marked by chronic
deficits in social communication and social interactions, as well as repetitive behaviors- stereotypy ,
activities or interests. The assessment of challenging behavior plays an important role in applied
research.

Most children with behavior disorders are escape maintained in that they engage in behaviors in order
to escape a demand (Cooper, Heron, & Heward, 2007). Once a child observes that engaging in a certain
behavior is effective at escaping the task, the frequency of that behavior increases leading to an escape-
maintained problem behavior. Young children with autism are particularly at risk for the development of
challenging behavior because of their delays in communication, language and social development.
Problem behavior, a form of communicative expression that is typical for young children without
disabilities, often remains in the communicative repertoire of the child with autism because it works for
the child ( Donnellan, Mirenda, Mesaros& Fassbender, 1984). The research synthesis by Horner et al.
(2002) showed that the early use of behavioral interventions can determine reductions of challenging
behaviors by up to 80–90% (Brosnan , Olive Healy, 2011).

Payne and Dozier (2013) have stated that although the efficiency of a treatment based on function is
proven, according to new studies, under certain conditions, positive reinforcement can be efficient in
reducing escape maintained behavior, even when extinction is not implemented. But escape from
instructional activities is a common maintaining variable for problem behavior. Escape or the social
negative reinforcement function, has been shown to be at least as prevalent as and sometimes more
prevalent than attention and automatic reinforcement functions. Individuals with disabilities are
frequently exposed to learning situations that target habilitative skills such as pre-academics, activities
of daily living, communication and social behavior among others. Unfortunately, certain aspects of the
instructional environment might become aversive and escape from them presents as a negative
reinforcer. Escape, or the social-negative reinforcement function, has been shown to be at least as
prevalent as, and sometimes more prevalent than, attention and automatic reinforcement functions (
Moore, Anderson and Kumar , 2005).

While many shows opposition to the implementation of a time out as a consequence for escape-
maintained abberant behaviors, certain researchers have observed that time out procedures are effective
when combined with escape extinction (Tiger. H. J., Hanley, P. G., Bruzek, J., 2008). Changing the non-
preferred stimulus associated with escape- maintained behaviors ( such as altering, fading or removing
the non- preffered stimulus) has been shown to be an effective method to decrease escape- maintained
abberant behaviors. Another study by Weeks& Gaylord- Ross (1981) demonstrated the existence of a
correlation between inappropriate behaviors and the difficulty of the task(Worcester L., McLaughlin
T.F., 2013).

Functional assessment is an empirically validated approach, used by many professionals - for

determining how a behavior relates to its environment. Based on the results of a functional assessment,
the treatment can be implemented, modifying the environment and teaching alternative behaviors that
serve the same function as the challenging behavior ( Carr& Durand, 1985). One method for teaching
alternative behaviors is FCT- Function Communication Training- the process is identifying the function
of problem behaviors ( like social attention or escape from demands) and teaching of an alternative
communicative response ( verbal or signs) that can produce the same outcome as those challenging
behaviors. Research has indicated the importance of reinforcing the desired communicative behaviors in
addition with providing extinction or punishment for problem behaviors to achieve succesfull outcomes
( Durand, Berotti, & Weigner, 1993; Shirley, Iwatta, Kahng, Mazaleski, & Lerman, 1997; Wacker et al.,
1990).

In the study by Fisher et al. (1993), FCT alone resulted in a 70% reduction of destructive behavior
only in one of the four participants. When comparing FCT alone with FCT with extinction and FCT with
punishment, the results showed that only FCT with punishment was the treatment package that produced
clinically singnificant reductions in destruction behavior and displayed generalization effects. The
results of this study offer continued support for the use of functional communication training procedures
to treat escape- maintained aberrant behavior.

A recent study of Piazza et al. ( 1997) examined the role of positive reinforcement in the treatment of
escape behavior. Given that the alternative behavior produced positive and negative reinforcement
whereas the problem behavior produced negative reinforcement only. It is unknown whether positive
reinforcement in isolation would effectively compete with negative reinforcement in isolation.

In this study, a functional analysis was used to identify the reinforce responsible for behavioral
maintenance so that could be used to strengthen an alternative response and to place the target problem
behavior on extinction.

Method

Participants and setting. R. is a 6 year old boy, diagnosed with autism and attention deficit disorder.
He started the therapy when he had 2 years old, he was able to follow three step instructions and he
could communicate in 3 word phrases. His score on the Autism Diagnostic Observation Schedule
(ADOS) was 12. The results suggests that he had problem behaviors, like flapping and pushing away the
therapist, who impeded his learning. He was taking medication, Strattera for deficit of attention. He
worked in a center of cognitive behavioral therapy, for four hours and then he spent the rest of the day at
home. R. engaged in high rates of flapping when the therapists ask him to do some simple math tasks.
The study took place in a center of congnitive behavioral therapy- “Help Autism”, in Bucharest,
Romania. Each session, including those for baseline and intervention phases, was 10 minutes in length.
Measurement and interrobserver agreement

R. problem behavior consist in lack of response, pushing away the therapist and flapping that last most
than 3 seconds. Each occurrence of R’s flopping was scored through a 10 minutes session.

Data was collected on a specialized data collection sheet and recorded with a pencil during all sessions.
Before intervention, the written consent from parents was taken, and prior functional analysis, S. was
exposed to a paired choise preferrence assessment (Fisher et al, 1992) to identify one moderately
preferred edible- chocolate and one moderately sensory item- the box full of coffee beans, chocolate and
the box full of coffee beans were selected to be used in functional analysis.

Functional analysis. Flapping was assessed using a multielement design based on the model described
by Iwatta , Dorsey, Slifer, Bauman and Richman (1982/ 1994), which included attention, demand, alone
and play sessions.

The sessions were conducted various hours of the therapy room, four days per week. Each session lasted
ten minutes, during which one of the 4 experimental conditions was in effect. This was followed by a
brief break in a different environment, then another 10 minutes in another condition. There where 4
sessions every day. Each condition was conducted a minimum of four separate times to ensure the
stability of the data. A total of 16 session were conducted in the therapy room.

In attention condition, moderately preffered toys were available in the room and contingent flapping,
the therapist provided S, social attention ( “You need to stay still!”) and brief physical contact. In the
escape condition, R’s therapist conducted instructional sessions ( “Let’s count the items on the table!”
“How many objects are on the table?”, “Give me one item!”, “How many items you gave me?”, “ Give
me 2 items”!), contingent upon flapping, the tasks where removed for 30 seconds. In the ignore
condition, R. was left alone in the room, without any leisure items. During play condition, the same
moderately preferred items were available, and in the absence of flapping for 30 seconds, the therapist
provide R. social attention (“ You are playing very nice!”).

Interobserver agreement

The purpose of assessing the IOA was to see whether the two independent observers recorded the
same event. There where used a partial interval recording procedure, during 10 minutes sessions. A
second observer simoultanously, but independently, scored the occurrence of screaming during 57% of
functional analysis sessions ( 9 sessions in 16 sessions) and 37% of treatment interventions (3 session in
8). Overall interobserver agreement was calculated on an interval by interval basis by dividing the
number of agreements by the total number of agreements and disagreements and multiplying by 100%.
Agreement scores were computed using a paper and a pencil, and every IOA was calculated after the
sessions and viewing the videotape ( see Appendix). Mean agreement for screaming was 100 %.

This is a recording strategy for behavior observations whether or not a behavior occurs in each session.
Each 10 minute session with the participant was broken down into one minute intervals for recording
data purposes. The occurrences of the escape behavior was recorded if he occurred at any point during
the one minute interval.
In functional analysis was used a partial interval recording, the experimenter recorded whether the
behavior occurred at any time during the interval (one minute interval, during ten minute session). In
treatment phase, the replacement behavior and the problem behavior were scored if occurred at any time
during one minute interval. So, the experimenter wasn’t concerned with how many times the behavior
occurred during the interval or how long the behavior was present, just that it occurred at any time
during the interval. The therapist scored the escape behavior- flapping , even if R. was disruptive only
for 10 seconds of a 60 seconds interval.

Functional analysis

100
90
80
70
Percentage of flapping

60
attention
50
demand
40
play
30
alone
20
10
0
-10
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Number of sessions Fig.1

During the alone condition, R. was placed in a room by himself with a room with no toys,
for a low stimulatory environment and he was recorded with a camera, for ten minutes and he did not
engaged in the inappropriate behavior.
During the attention condition, the experimenter responded to inappropriate behavior delivering
a reprimand (e.g., “Don’t move your hands!”, “You need to stay still!”). During this time, R. engaged in
the inapropriate behavior 1 time in the first sitting ( 10%), 2 times in the second sitting (20%), 0 times in
the third second and 1 time in the four sitting(10%) .
During the play condition, R. had access to his favorite activities and the experimenter delivered
noncontingent attention every 30 seconds with no specified consequence for inappropriate behavior and
the inappropriate behavior didn’t appeared.
The demand condition consisted of four simple math instructions and each occurrence of
inappropriate behavior was followed by 30 s of escape from the task. During this time the behavior
appeared the most, in first session the behavior appeared 9 times, in the second session the behavior
appeared 8 times, 9 in the third and same in the fourth session.
The data from the graph allows us to observe that the behavior function in escaping the task, R.
engages in inappropriate behavior- flapping and pushing away the therapist when makes demands and
instructs him. This behavior was home maintained, because every time when his parents tried to do
simple math tasks, he was flopping and they live him alone, not trying to do the tasks anymore. The
selection of the replacement behavior was made based on that function.

Treatment
An A- B design was used. The baseline was identical with the demand condition from the functional
analysis- but were introduced 4 more sessions to have a stability data, the sessions took place in the
therapy center, recording the occurences and nonoccurences of flapping, during 1 minute. During the
baseline condition, the therapist made instructions and everytime the child engaged in the problem
behavior, the therapist stopped giving the instructions and gave the child 30s escape from task. During
baseline, R. was engaged in high rates of problem behavior and never had an alternative for asking for a
break.
Based on the results of the functional analyses, the treatment consisted of Functional
Communication Training (FCT) and Extinction (EXT). The child was taught that when he wanted to
flapp or push away the therapist in order to obtain a break to say the word “Break”. Prior to
implementing FCT, R. was prompted to emit verbal responses to obtain a pause (‘‘Break.’’) and R. was
able to emit this verbal response.
 Step 1: the therapist anticipated, during the sitting session, behaviors that preceded the behavior
of pushing away the therapist, R. was prompted to ask for a break.
Step 2: the therapist did not prompt him to say “Break”, and provided the child with descriptive
praise (‘Good asking for a “Break.”) and a 30 seconds time-out from the task contingent. In this manner,
the subject escaped each request contingent on the specific verbal request “Break”. Also, the therapist
started to put on extinction the behavior of throwing himself down or pushing the therapist and
continued to instruct and physically prompt him when the child failed to offer a response. The therapist
allowed 3s to emit the correct response for simple math tasks or the trained verbal request for the break
independently, then provided a prompt. Contingent noncompliance, the therapist modeled prompts for
the appropriate response.
Step 3: the therapist provided consequences for R’s behavior when the replacement behavior
takes place. The therapist immediately provided the participant with his or her reinforcer upon the
participant’s successful use of a replacement behavior- asking for a break. R’s problem behavior was
ignored- flapping (i.e., placed on extinction) while the replacement behavior was reinforced.
Results. We used an AB design to assess the effects of the intervention, and the results of the training
are showed below.

Baseline FCT+ EXT Follow- up

100
90
80
70
60
50
40
30
20
10
0
-10
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
 Percentage of flapping

According to Figure 1., functional analysis showed that destructive behavior ( flapping and
pushing away the therapist) was maintained by negative reinforcement (escape).
In Baseline a high number of inappropriate behaviors could be observed, such as: during the first
session 90% percentage of escape from task behaviors, followed by session no 2, which the behavior
manifested 80%. In the last 6 sessions the behavior manifested constantly, which lead to the starting of
the intervention.
After FCT and EXT, flapping decreased at very low rates ( in session no 5, it appeared only 7
times, in session no 6- 6 times, session no 7- 7 times, session no 8- 4 times, session no 9- 3 times, and
session no 10- only 2 times) and in 3 sessions, flapping
Number not occurred at all. Because was used and A- B
of sessions
design, the experimental control can not be demonstrated and even if return to baseline, the flapping
level will be very low, because now, R. know to ask appropriate for a break. Looking on the graphic, we
can see that the treatment is effective.

Follow-up. Two weeks after the treatment was implemented, follow- up data were collected in the
therapy room. The level of flapping was zero. The next step was to implement the treatment at home and
when he will follow the kindergarten, also.

Discussion

The purpose of this study was to asses the function of problem behavior- flapping, and replacing this
challenging behavior with an appropriate behavior- asking for a break and evaluate the effects of FCT
and EXT as a potential treatment for decreasing this problem behavior. Results of the functional analysis
confirmed that S. was engaged in problem behavior, maintained by escape for demands. Treatment with
FCT and EXT resulted in a decreased in flapping and an increase in using appropriate communication.

One limitation of the study is that we were not able to return to baseline, in a reversal design, to
demonstrate experimental control, but after looking on the figure 2, we can see that FCT+ EXT is an
effective treatment, because flapping is 0. The treatment derived from functional analysis was rapidly
effective- only 10 sessions, which likely wouldn’ t happened if the treatment have been based on the
descriptive assessment.

A possible continuation of the study could be introducing a time delay between the communicative
response and reinforcement (the escape) or fading demands, such as removal aversive task, which
remain absent until they are systematically and gradually faded back in.
References

American Psyhiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, Fourth
Edition, Text Revision. Washington, DC, American Psyhiatric Association.

Borrero, J., C., & Borrero, C., S., W., (2008). Descriptive and experimental analyses of potential
precursors to problem behavior. Journal of Apllied Behavior Analysis, 41, 83- 96.

Carr, E. G., & Durand, V. M. (1985). Reducing behavior problems through functional communication
training. Journal of Applied Behavior Analysis, 18, 111- 126.

Cooper, J. O., Heron, T. E., & Heword, W. L. (2007). Applied Behavior Analysis (2-nd edition), Upper
Sadle River, New Jersey: Person Prentice Hall.

Dunlap, G., & Fox, L. (2011). Function-based interventions for children with challenging behavior.
Journal of Early Intervention, 33, 333- 343.

Durand V.M., Carr E.G. (1991) “Functional communication training to reduce challenging behavior:
maintenance and application in new settings”, Journal of Applied Behavior Analysis, 24(2), 251-264.

Durand, M., & Merges, E. (2001). Functional communication training: A contemporary behavioral
analytic intervention for problem behaviors. Focus on Autism and OtherDevelopmental Disabilities, 16
(2), 110-119.

Fisher W., Piazza C., Cataldo M., Harrell R., Jefferson G., Conner R., (1993),“Functional
communication training with and without extinction and punishment”, Journal of applied Behavioral
Analysis, 26(1), 23-26.

Geiger B.K., Carr J.E., LeBlanc A.L., (2010), “Function-Based Treatments for Escape-Maintained
Problem Behavior. A treatment-selection Model for Practicing Behavior Analysts”, Behavior Analysis
in Practice, 3 (1), 22-32.

Hagopian, L. P., Fisher, W. W., Sullivan, M. T., Acquisto, J. A., & LeBlanc, L. A. (1998). Effective of
functional communication training with and without extinction and punishment: A summary of 21
inpatient cases. Journal of Applied Behavior Analysis, 31(2), 211-235.

Hanley, G. P., Iwata, B. A., & McCord, B. E., (2003). Functional analysis of problem behavior: A
review. Journal of Applied Behavior Analysis, 36, 147-185.

Horner, R. H., Carr, E. G., Strain, P. S., Todd, A.W., & Reed, H. K. (2002). Problem behavior
interventions for young children with autism: A research synthesis. Journal of Autism and
Developmental Disorders, 32 (5), 423-446.
Horner H.R., Day H.M., Sprague R.J., Heathfield L.T., (1991) “Interspersed requests: a nonaversive
procedure for reducing aggression and self-injury during instruction”, Journal of applied behavior
analysis 24(2), 265-278.

Iwata, B. A., Dorsey, M. F., Slifer, K. J., Bauman, K. E., & Richman, G. S. (1994). Toward a functional
analysis of self-injury. Journal of Applied Behavior Analysis, 27, 197-209. (Reprinted from Analysis and
Intervention in Developmental Disabilities, 2, 3-20, 1982).

Kuhn, D. E., Hardesty, S. L., & Sweeney, N. M. (2009). Assessment and treatment of excessive
straightening and destructive behavior in an adolescent diagnosed with autism. Journal of Applied
Behavior Analysis, 42, 355-360.

Lalli, J. S., Casey, S., & Kates, K. (1995). Reducing escape behavior and increasing task completion
with functional communication training: Extinction, and response chaining. Applied Behavior Analysis,
28, 261-268.

Lord, C., Rutter, M., DiLavore, P. C., Risi, S. (1999). Autism Diagnostic Observation Schedule-
WPS (ADOS-WPS). Los Angeles, CA: Western Psychological Services.

Moore D.W., Anderson A., Kumar K., (2005), “Instructional Adaptation in the Management of escape
– maintened Behavior in a Classroom”, Journal of Positive Behavior Interventions, volume 07, no 4,
216-223.
Payne W.S., Dozier.C . (2013) “Positive reinforcement as treatment for problem behavior maintained by
negative reinforcement.”, Journal of applied behavior analysis, 46 (3), 6

Shirley J.M., Iwata A.B., Kahng W.S., Mazaleski L.J., Lerman C.D.(1997), “Does functional
communication training complete with ongoing contingencies of reinforcement? An analysis during
response acquisition and maintenance, Journal of Applied Behavior Analysis, 30(1), 93-104, 99-703.

Wacker, D. P., Steege, M. W., Northup, J., Sasso, G. M., Berg, W., Reimers, T. (1990). A
component analysis of functional communication training across three topographies
of severe behavior problems. Journal of Applied Behavior Analysis, 23, 417-429.

Worcester L., McLaughlin T.F., (2013), “Comparing Effective Treatments for Attention Maintained
and Escape- Maintained Behaviors in Children with Behavior Disorders:
Brief Review and Analysis”,
International Journal of Basics and Applied Sciences, 1(3), 621-627