A Practical Guide to Functional Assessment and Treatment for Severe Problem Behavior

Part 1: Introduction to Behavioral Assessment and Intervention

1. Problem Behavior
How we define problem behavior (functional and structural definitions; what is the meaning of “severe”)
Decision model for determining severity
When is automatically maintained problem behavior considered severe
How it is socially impactful; how it can impact Quality of Life (QoL)
In the classroom
In the home
In the clinic o Epidemiology and risk factors


2. Applied Behavior Analysis and Problem Behavior
Primer in ABA principles and historical influence of ABA in severe problem behavior
Historical development of behavioral assessment (Skinner definitions of functional assessment and functional analysis; Gold et al., 1964; Carr 1977; Carr and Durand, 1985)
Rationale for functional assessment (develop understanding; reduce interpretative leap, focus on current malleable environmental factors)
Rationale for function-based treatment: (when) does it improve upon no treatment or non-function-based treatment? And by how much?


3. A Perspective on Today’s Applied Behavior Analysis
Values-based movement
Importance of neurodiversity
Meaningful changes and social validity, reduction in severe problem behavior, increase in child skills, improvements in Quality of Life for child / client and others around them
Ethical considerations for functional assessment and function-based treatment; exposure to risk for individual, therapists and family; benefits to function-based treatments


4. Prevention and Behavioral Hygiene Procedures
Right to effective treatment standards for humane and responsive environments
Promoting and maintaining child / client engagement, physically and socially rich environment, elimination of aversive stimuli
Universal protocols for maintaining joy and avoiding severe problem behavior
Routine skills training including mand training and Life Skills Training Program
Include Brief Vignette based on your experience

Part 2: Functional Assessment of Problem Behavior

5. Indirect Assessments
Definition of indirect assessments (no observation; no manipulation)
General features (closed/open ended questions; qualitative/quantitative recording of data)
Different examples
Interviews (Miltenberger and Iwata; Hanley)
Questionnaires: (QABF, FAST, MAS, open-ended assessment)
Include Brief Vignette based on your experience


6. Descriptive Assessments
Definition of descriptive assessments (observation; no manipulation)
General features (closed/open ended reporting; qualitative/quantitative recording of data)
Different examples (ABCs, scatterplots, approach and avoidance behavior, brief contingency probe)
Include Brief Vignette based on your experience


7. Functional Analysis o Definition of functional analysis (observation; manipulation)
General features (five core components)
Integration and testing of hypotheses from indirect and descriptive assessments into functional analyses
Methods
Standard
Brief
Trial-based
Latency-based
IISCA
Integrative methods
Creative / idiographic approaches to functional analysis o Include Brief Vignette based on your experience

Part 3: Function-Based Treatments

8. Practical Considerations
Strengths and limitations (predictive validity, incremental validity and costs of FA methods)
Comparing and contrasting models § Least-to-most intrusive
Combined approach § Using indirect, descriptive, and functional analyses


9. General Treatment Strategies
Antecedent-based Strategies: EO strategies
Antecedent-based Strategies: discriminative stimuli strategies
Reinforcement-based Strategies
Reinforcement thinning (multiple schedules, chained schedules, delay fading)
Collecting, graphing, and analyzing treatment data
Visual analysis
Making informed treatment choices


10. Comprehensive and Trauma-Informed Treatment Strategies
Trauma-Informed Framework
Functional Communication and Complexity Training
Delay and Denial Tolerance Training
Include Brief Vignette based on your experience


11. Automatic Reinforcement
Attempts at function-based (helmets, gloves, numbing cream)
Delineating subtypes of auto SIB (Hagopian stuff)
Informing treatments based on subtypes
Non-function-based interventions
Include Brief Vignette based on your experience

Part 4: Promoting Sustainability and Compassionate Care

12. Application Considerations
Compassionate care
Cultural sensitivity
Programming resilience
Generalization
Maintenance
Include Brief Vignette based on your experience


13. Professionals / Caregiver Training
Differences in professional and caregiver training o BST
Skill acquisition
Programming generalization and maintenance
Pyramidal training systems
Seminar-based training
Coaching
Strengths and limitations of each approach
Include Brief Vignette based on your experience


14. Implementation Considerations
Treatment integrity
Clinical issues [resistance to implementation from all audiences]
Role of consultants; consultant skill set
Common ethical issues o When function-based treatments do not work
Management of restrictive practices, restraints, meds, integrating meds into behavioral approaches etc.
Include Brief Vignette based on your experience


15. Collaborating with Relevant Stakeholders
Introduction to team-based treatment
Different systems and stakeholders
Interdisciplinary care
Roles and responsibilities of team members
Appropriate team membership
Scope of competency
Ethical dilemmas when working with other disciplines
Determining environmental v. biological influence