Using The Power of Functional Communication Training (FCT) to Reduce Severe Problem Behaviors In Persons With Autism

The author is a Board Certified Behavior Analyst working with Behavior Momentum India. The views in this blog are his own. I hope to keep in mind parents and therapists as I write and will try to keep the jargon to a minimum. Do feel free to contact me via smbehavioranalysis@gmail.com

Tiger et al., (1998) state that “Functional communication training (FCT) is one of the most common and effective interventions for severe behavior problems” (p.16). Problem behaviors often occur because of single or multiple factors. A person with a Learning disability with a weak or underdeveloped communication may engage in aggressive behaviors, self-injurious behaviors or what are commonly called tantrums and sometimes meltdowns. The reason may be wanting to get something (for example Tv time) or to escape from tasks (When I start shouting and beating myself people around move away and leave me alone) or to get adult attention. Sometimes it can be a combination of functions. For example, ‘I escape from academic task and I also get a nice toy to play with’.  The function of the problem behavior is first determined by a behavior analyst (The methods for identifying the function is beyond the scope of this article, readers are directed to check articles on Functional Behavioral Assessment and Functional Analysis). Thereafter, depending on the functional diagnosis, one of the powerful options parents and caregivers have is to teach Functional Communication.

While I attempt to explain the mechanism and the challenges, I would urge the reader to practice this only under expert ( Read, BCBA, one of my fellow tribesperson) guidance. Otherwise, there is a risk of serious harm and it may be downright unethical.

How is FCT done? It involves setting the context for problem behavior to occur and then teaching the person to request for the item or action that used to maintain the problem behavior as determined by Functional Assessment. This could be a play item, TV time or break from the task. The request can be taught to be made using speech, sign language, a card with the request written on it, or a communication device.  Such a request, appropriately made is called a Functional Communication Response (FCR).  The prompts used to teach the FCR should be faded in subsequent training. Alternately, a pause before the prompt (called time delay) can be introduced to provide an opportunity for independent responding.

In the early stages, it is easy for the child or person to rapidly go into the problem behavior mode than to make a request as the latter behavior is just not there in their repertoire while they have been successful many times in the past with the former. I have come across children who would run, dash and grab what they want or hit out at others at such a great speed (imagine Jackie Chan or Jet Li) that it would look very difficult to teach them that they just need to, well, request appropriately. So, the prompting will need to be rapid and providing the item or break or attention (depending on the function) will have to be immediate and every time a request is made in the early stages.

In the same breath, we also must talk about procedures to train some level of acceptance of denials and non-availability. It may not be realistic to honor a request for a chocolate or TV time or break from task every time the person makes a request, even if it is made very politely and nicely (some young ones, once they learn manding or requesting works, are known to become mand monsters!). However, during periods of denial, we would not want the problem behavior to re-emerge. This process can be challenging and hence there is a school of thought of that FCT is best implemented by experienced Behavior Analysts and well-trained staff only. However, there are studies where parents and caregivers have also been trained by Behavior Analysts to implement FCT with success. See Harding, Wacker, Berg, Lee, & Dolezal (2009).

If you are already into managing problem behavior using Functional Communication Training there are some additional considerations and you may want to read further. I attended some great research presentations at the recent 43rd Annual convention of ABA International (May 2017) that have answers to several of these questions. You may want to read the below with one or two real-life clients of yours in mind who could benefit from FCT.

1.What if the person makes requests (FCR) at an unacceptably high rate – Life can be miserable for parents or caregivers?

We must embark on what is called ‘thinning’ the schedule. Simply put it means finding ways to reduce the number of times parent or caregiver needs to accede to the requests without the problem behaviors reappearing. While initially every request may be honored, in later stages tasks can be introduced (complete these two tasks and then you can have a break) and the number of chained tasks can be increased with improving success at previous levels. Another effective option is to use certain stimuli (Example – a green card, a purple armband) to signal when a request will be honored. When this signal is not present the person is taught that the request cannot be honored. To ensure aggression does not come back it is important to have the signal ‘on’ more often initially. With success, the duration of ‘on’ time can be reduced.

2. Prompting options:

Landa, Hanley, and colleagues (May 2017) examined questions related to prompting procedures. The first procedure involves, as described earlier, a brief delay before the FCR is prompted to provide an opportunity for independently requesting. Problem behavior should not contact the desired event. A second procedure, called most to least prompt, requires starting with an immediate prompt and introduce delays of 1-3 seconds in subsequent trials.  In this procedure, if the problem behavior occurs, the prompt for an appropriate response can be immediate or we could wait until the problem behavior subsides and then provide the desired event (access to edible/ tangible/attention/ escape from tasks or a combination as determined from functional analysis of problem behavior). Based on successful treatment of 4 children with aggressive behaviors they found that, where problem behavior occurred, 8 out of 11 times, immediate prompting (rather than waiting for the problem behavior to go) helped in the children’s acquisition of an appropriate requesting (FCR)  and high rates of aggressive behaviors were reduced to zero. In other words, don’t be afraid to prompt the request as soon as problem behavior occurs.

3. The form of functional communication response:

Initially this decision must be based on what is easiest for the person – For example, saying “my way” or showing a card that has ‘my way’ printed, Signing or pressing a button on a speech generating device. The request can also be more specific such as “chips”, “ iPad” or “TV time.  With success in initial stages more natural and complex forms can be examined (” please, I need a break”). The important criterion is that the action should be easier and faster to do than the problem behavior.

In summary, there are a number of variables that can be manipulated and even after being amongst the most researched topics in Behavior Analysis, FCT continues to attract wide attention from practitioners and researchers for the promise it holds to manage severe problem behaviors. The appropriate requesting, even if trained in one controlled setting must generalize to other events that the person would want to manipulate in different settings such as home, school, malls, friend’s homes, and workplace. The art and science of Generalization is another topic to be looked at next.

Selected References:

Carr, E. G., & Durand, V. M. (1985). Reducing behavior problems through functional communication training. Journal of Applied Behavior Analysis, 18(2), 111-126.

Harding, J. W., Wacker, D. P., Berg, W. K., Lee, J. F., & Dolezal, D. (2009). Conducting Functional Communication Training in Home Settings: A Case Study and Recommendations for Practitioners. Behavior Analysis in Practice, 2(1), 21-33.

Lalli, J. S., Casey, S., & Kates, K. (1995). Reducing escape behavior and increasing task completion with functional communication training, extinction and response chaining. Journal of Applied Behavior Analysis, 28(3), 261-268.

Landa, R.K., Hanley, G.P., Gover, H., Rajaraman, A., Ruppel, K., & Ghaemmaghami, M. (2017). An Evaluation of Prompting        Procedures during Functional Communication Training.( Powerpoint slides). Presentation at ABAI, 43rdAnnual convention, Denver

Tiger, Jeffrey H., Gregory P. Hanley, and Jennifer Bruzek. “Functional communication training: A review and practical guide.” Behavior Analysis in Practice 1.1 (2008): 16-23.

Sridhar Aravamudhan, M.A ( Applied Behavior Analysis), BCBA

Sridhar Aravamudhan is a Board-Certified Behavior Analyst with 9 years experience and works with Behavior Momentum India (BMI; www.behaviormomentum.com). Sridhar is part of the research team at BMI . His research interests include teaching conditional discriminations, interventions for articulation disorders and precision teaching. He occasionally blogs with a view to making behavior analysis more intelligible to parents, therapists and students.  You could connect with him on FB https://www.facebook.com/smbehavioranalysis or via email smbehavioranalysis@gmail.com