Harnessing Communication Preferences to Enhance Its Persistence and Mitigate Relapse of Challenging Behavior

University Of Georgia, Athens GA

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Abstract

PROJECT SUMMARY/ABSTRACT Individuals with intellectual and developmental disabilities (IDD) often exhibit behavior that poses a risk to themselves (e.g., self-injurious behavior), others (e.g., aggression), or their environment (e.g., property destruction). These challenges can limit their ability to participate in meaningful social, educational, and vocational activities. The aims of the current project are to demonstrate an approach to a behavioral intervention (functional communication training [FCT]) to (1) promote long-term maintenance and resilience in the face of disruption and (2) evaluate its relation to response and participant variables. FCT is the most widely researched behavioral treatment to address challenging behavior exhibited by individuals with developmental disabilities. This treatment involves teaching appropriate communication to replace challenging behavior as a way of recruiting reinforcers. For example, teaching an individual to use a speech generating device to request parent attention instead of engaging in inappropriate attention-seeking behavior (e.g., aggression). Its efficacy has been demonstrated in hundreds of published studies, but it remains important clinically to develop treatment components that influence treatment maintenance when FCT encounters disruptions (e.g., communication “no longer works” or new contexts are encountered). Treatment maintenance includes both (1) enhancing persistence of appropriate communication and (2) reducing relapse of challenging behavior. Recent research suggests that designing FCT based on an individual’s preferred communication modality (a) reduces challenging behavior, (b) teaches an appropriate communicative response, (c) increases the persistence of the functional communicative response (FCR), and (d) reduces relapse of challenging behavior. However, the existing literature surrounding preference of communication modality is composed of a small number of investigations employing single-case experimental designs. While promising, these examples lack demonstration that communication-modality preference improves treatment maintenance in the context of a randomized controlled trial, considered the gold-standard for intervention research. The proposed study will intentionally compare FCT that incorporates an individuals’ preferred communication modality (PrefFCT) to FCT that incorporates an equally successful communication modality, but one that is less preferred (NonPrefFCT). Treatment maintenance will be compared across both modalities (PrefFCT and NonPrefFCT) in a randomized controlled trial by two relevant outcomes: (a) the persistence of the FCR and (b) relapse of challenging behavior, when disrupting treatment with both reductions in reinforcer rate and context/implementer changes. Quantifying effectiveness of preference modality with an RCT will contribute to enhancing dissemination and adoption of this approach by practitioners. The outcomes of the proposed research will contribute to enhanced quality of life for individuals with IDD by optimizing FCT to improve communication and reduce challenging behavior.