Idea Transcript
Functional Assessment & Analysis
1
Functional Assessment/Analyses As with behavioural ABC’s, functional assessment/analysis entails assumptions about the environmental conditions and motivational properties that promote or maintain inappropriate and appropriate repertoires with a view to designing treatment programmes that correct or nullify the effects of an individual’s motivational history with respect to that problem The concern from which these techniques emerged arose in part from the search for reinforcement-based procedures that would produce reductions in behaviour disorders, often involving challenging behaviour, similar to those effects observed with punishment techniques
2
Functional Assessment/Analysis Functional Assessment Provides correlational information regarding variables controlling behaviour Functional Analysis Involves the systematic manipulation of hypothesised variables in order to empirically verify the existence of causal relationships in behaviour
3
A Functional Approach Functional Analysis has been used successfully in: Stereotypy (Durand & Carr, 1987) Disruption (Carr & Durand, 1985) Self-injurious behaviour (SIB) (Day et al., 1988) Aggression (Slifer et al., 1986) Pica (Mace & Knight, 1986)
4
Functional Analysis Carr ’77 was the first to suggest that inappropriate behaviour (i.e. challenging behaviour) may be related to the social context and the individual’s access to social consequences Iwata subsequently developed a functional-analytic model of the assessment and treatment of inappropriate repertoires This was primarily a two-event response-consequence model with little emphasis on the role of antecedents
Response
Consequence 5
Functional Assessment/Analysis Other researchers, however, developed a model of functional analysis that placed emphasis on the role of establishing events For example, Durand ’90 described a four-event model that incorporated a detailed examination of the full context that gives the behaviour meaning
6
A 4-Term Contingency SETTING EVENTS
STIMULUS EVENTS
RESPONSE CLASSES
CONSEQUENT EVENTS
7
Setting Events Setting events are contextual influences that are concurrent with the problem behaviour and/or are distant in time Physical setting events directly affect stimulus events, but not the problem behaviour itself, they alter the sensitivity of the behaviour to the stimulus events, such that they may have more or less an impact upon it
8
Setting Events Biological Illness/Pharmacological/Organic (otitis media associated with CB)
Social General administrative context/Specific social contexts
Physical
9
Biological Setting Events •
Illness/abnormal biological condition Biological setting events for challenging behaviour (CB), for example, are particularly prevalent in the following genetic syndromes: Lesch-Nyhan Syndrome Almost 100% predictor of CB -- individuals have a tendency to bite flesh with similar topographies Prader-Willi Syndrome Obsessive about food (obesity is a serious problem) -- common topographies include skin-picking of thighs and backs of hands
10
Biological Setting Events (Illness) A straight relationship between the topography of CB and the presence of a specific biological condition is less apparent in the following: Rett Syndrome Joubert Syndrome Fragile X Syndrome
11
Biological Setting Events (Illness) Medical conditions may also enter into a relationship with social contingencies to exacerbate CB because some conditions are accompanied by very severe developmental disability and hearing/visual impairment (including no language) which can correlate with CB Up to 80% of developmentally disabled individuals have severe sleep problems, also associated with increased levels of CB Many genetic conditions also involve increased susceptibility to illness (e.g. influenza)
12
Biological Setting Events (Pharmacological) • Pharmacological interventions Approx. 45% of CB clients are on medication Anti-psychotics (Thioridazine or Risperidone) You can get psychosis with MR -- some clients do respond well to antipsychotic medication, but their efficacy is neither tested nor monitored Anti-epileptics (Carbamezapine or Clonazepam) Epilepsy is common and a relationship has been identified between epilepsy and aggression
13
Biological Setting Events (Pharmacological) Anxiolytics (Diazepam or Triazolam) Stimulants (Methylphenidate) Opiate Antagonists (Naltrexone) Some researchers have suggested that severe SIB yields an opiate high and naltrexone is used to block the release of brain opiates
14
Biological Setting Events (Pharmacological) Carr ‘82 suggested that medication may enhance the effectiveness of behavioural interventions when he observed that combining a behavioural intervention with haloperidol maintained low frequency of SIB, whereas removing either intervention increased the frequency Podboy & Mallery ‘77 observed that reducing caffeine intake resulted in decreases in aggressive outbursts
15
Social Setting Events (General) Even the general social context (in terms of acceptable social policy or regulations) can have a significant effect on problem behaviour For example, Durand ‘83 observed a decrease in absenteeism rates and in levels of problem behaviour following the implementation of a new policy for absenteeism When the previous policy on absenteeism was reinstated, high rates of both absenteeism and problem behaviour were reinstated
16
Social Setting Events (Specific) Very specific social setting events may also affect problem behaviour Gardner, Cole, Davidson and Karan ’86 demonstrated that aggressive outbursts displayed by one individual were more likely to occur following a home visit with his brother and the subsequent presence of a male staff member in residence Lovaas and Simmons ’69 found decreases in SIB in the presence of one experimenter and increases in the presence of another experimenter
17
Physical Setting Events Commonly-observed physical setting events that correlate with problem behaviour include: - physical crowding - clothing - noise levels - various physical arrangements
18
A 4-Term Contingency SETTING EVENTS
STIMULUS EVENTS
RESPONSE CLASSES
CONSEQUENT EVENTS
19
Stimulus Events Stimulus events are influences that are simple, discrete and immediate antecedents Stimulus events are influenced by setting events but the relationship is not reciprocal However, there is a reciprocal relationship between stimulus events and the problem behaviour itself and between the problem behaviour and its consequences Stimulus events are like establishing operations that influence the power of reinforcement
20
A 4-Term Contingency SETTING EVENTS
STIMULUS EVENTS
RESPONSE CLASSES
CONSEQUENT EVENTS
21
Consequent Events Positive Reinforcement Developmentally delayed individuals are particularly susceptible to positive reinforcement for inappropriate responding because they have limited repertoires for engaging attention or desired objects Lovaas and Simmons ’69 demonstrated that levels of SIB increased when consequated by social attention Lovaas, Freitag, Gold and Kassorla ‘65 found that higher frequencies of SIB occurred with intermittent rather than continuous reinforcement
22
Consequent Events Negative Reinforcement Developmentally disabled individuals (with limited other means) are known to frequently engage in non-compliance, tantrums, disruption, destruction, aggression and SIB in order to have aversive events removed
23
Consequent Events Automatic Reinforcement Some behaviours appear to emerge/continue independently of environmental factors These may generate positive reinforcement by providing stimulation or negative reinforcement by avoiding an aversive psychological state Under-stimulated environments are often found to be powerful antecedent events for behaviours that provide automatic reinforcement
24
Functional Analysis How To Do It
25
Functional Assessment The focus of the assessment is not on the topography of the behaviour but on its function Provides knowledge of discriminative/motivational conditions that evoke the target behaviour, rather than simply selecting a treatment designed to be decelerative or suppressive in function Provides knowledge of reinforcing consequences contingent upon the target rather than an emphasis on desired change Gives some indication of more efficient or socially appropriate behaviours
26
Behavioural Interview The target operant response classes are defined by interviewing significant others in a behavioural interview The basic aim is to generate a large number of potential variables and then focus on those that appear to be influential A number of behavioural rating scales, checklists and questionnaires are available for this purpose One of the most frequently used is the Motivation Assessment Scale (Durand & Crimmins, 1988)
27
Example of Behavioural Interview & Case Study 2
28
Behavioural Assessment The individual should be observed in the typical daily routine (or relevant context) in as many settings and across as much time per day as possible for a minimum period of 2-5 days It is important to note that NO manipulation of variables occurs at this time Two types of descriptive analyses can be used to record information during this time One method of recording events during the behavioural assessment is with the use of a Scatterplot Assessment that records temporal distributions of behaviour
29
Scatterplot Grid 9
3 Occ.
30 Time of Day 30-Min Intervals
2 Occ.
10 30
1 Occ.
11 30 12 30 8/9
9/9
10/9
11/9 12/9 13/9 14/9 Date
30
Functional Analysis Functional analysis is a multi-element, semi-random design with 4 social conditions (hypotheses) used to determine the social contingencies possibly responsible for maintaining problem behaviour - Attention condition - Task condition - Alone condition - Play condition
31
The Attention Condition General Hypothesis: Positive reinforcement is contingent on the problem behaviour More specifically, problem behaviour may be maintained by attention (i.e. it has a communicative function) and thus the therapist ignores the client until he engages in the target and then attends with something like “Stop that” Positive reinforcement may also be generated by the contingent provision of tangible consequences such as food (Doss, 1988), toys, or preferred activities (Lovaas & Simmons ‘69)
32
Task/Demand Condition Hypothesis: Negative reinforcement is contingent upon the problem behaviour (i.e. avoidance or escape function) If problem behaviour occurs during a task or demand situation, the demand is removed for 10-s or until the behaviour stops, and then the demand is returned Carr and Durand ‘85a demonstrated that problem behaviour increased following the introduction of aversive stimuli, such as difficult task demands
33
Alone Condition Hypothesis: Positive biological reinforcement is contingent upon the problem behaviour (i.e. self-stimulatory function) -- functions of this kind often indicate the presence of medical conditions These reinforcers may be: - Auditory - Visual - Tactile Favell et al ‘82 demonstrated that problem behaviour decreased with alternative means of obtaining the sensory feedback
34
Play Condition This is an enriched or stimulating environment, used as a comparison with the other three conditions It is used as a control condition for the attention and demand conditions because it contains non-contingent attention and the absence of demands In this condition no demands are placed on the individual and attention is provided non-contingently
35
Multiple Influences Complexity arises when operant responses appear to be multi-functional in that they have more than one type of function For example, Durand ‘82b, observed that face-hitting for one individual was maintained both by sensory feedback and escape
36
Psychotic Speech Functional analysis has been included in programmes designed to establish communication skills Durand and Crimmins (1987) found the peculiar speech of one adolescent (“Parachute now” and “Fried eggs on your head”) to be a means of removing the individual from aversive situations The individual was taught to say “Help Me” in an effort to reduce the unpleasantness of the aversive events Thus when formally and appropriately requesting assistance, the individual also obtained more trainer prompts and some of the difficulty was thereby reduced
37
% of Intervals of Psychotic Speech Baseline
“Help” + Ass
Baseline
“Help” + Praise
“Help” + Ass
50 45 40 35 30 25 20 15 10 5 0 SESSIONS
38
Individual Differences One individual’s aggressive act may be a function of positive reinforcement, whereas another individual’s aggression may be negatively-reinforced by escape For example, extinction in the form of time-out is often used to eliminate problem behaviour based on the assumption that it reduces access to stimulation This may prove effective for behaviour maintained by positive reinforcement but would only serve to reinforce an escape response
39