Stimulus Control Refinements of Functional Communication Training in ID

ID功能性沟通训练的刺激控制改进

• 批准号: 10246190
• 负责人: WAYNE WILLIAM FISHER
• 金额: $ 47.48万
• 依托单位: RBHS-ROBERT WOOD JOHNSON MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-07-11 至 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10246190
• 关键词: Aftercare; Aggressive behavior; Attention; Behavior; Behavior Disorders; Behavioral; Caregivers; Child; Clinic; Communication; Community Integration; Data; Developmental Disabilities; Educational Intervention; Effectiveness of Interventions; Exhibits; Extinction (Psychology); Family; Home; Individual; Institutionalization; Intellectual functioning disability; Meta-Analysis; Outcome; Pharmaceutical Preparations; Physical Restraint; Play; Procedures; Psychological reinforcement; Punishment; Randomized Clinical Trials; Reinforcement Schedule; Relapse; Research; Research Personnel; Risk; Schedule; Self-Injurious Behavior; Services; Severities; Signal Transduction; Social isolation; Stimulus; Techniques; Testing; Thinness; Time; Training; Treatment Effectiveness; alternative communication; autism spectrum disorder; base; behavioral momentum; comorbidity; compare effectiveness; effective therapy; epidemiology study; improved; novel; prevent; reinforcer; response; theories; treatment effect

Project Summary Severe destructive behavior represents a comorbid condition of developmental disability for which risk increases with intellectual disability severity, communication deficits, and co-occurring autism spectrum disorder.24,78 Destructive behavior, such as self-injurious behavior and aggression, causes harm to the child and others and increases the risk for institutionalization, social isolation, physical restraint, medication over- use, service denial, and abuse.79 Clinicians have used functional analyses to identify the variables that reinforce or motivate destructive behavior and to develop effective, function-based treatments.4 Functional communication training (FCT) is an empirically supported, function-based treatment that decreases destructive behavior. The clinician teaches the child to use the functional communication response (FCR) to request the reinforcer for destructive behavior, and destructive behavior is on extinction during FCT.6,39 For example, if functional-analysis results showed that attention reinforced destructive behavior, the clinician would provide attention when the child used the FCR (“Play with me, please.”) and would not provide attention for destructive behavior. One limitation of FCT is that relapse, an increase in destructive behavior after initially effective treatment, often occurs when we transfer treatment to new therapists, caregivers, or settings or when change agents implement it incorrectly.8,39,80,81 Behavior analysts describe relapse as (a) renewal when the treatment context changes (e.g., transfer treatment from clinic to home),12 (b) resurgence when the FCR does not produce reinforcement,82 and superresurgence when renewal and resurgence co-occur and cause higher levels of relapse than that produced by either alone,14 and (c) reinstatement when the caregiver mistakenly provides reinforcement at unplanned times.83 Our research from Period 1 of this project, based on behavioral momentum theory, suggested that signaling when the FCR will and will not produce reinforcement during our multiple-schedule FCT (mult FCT) procedure: (a) prevented extinction bursts, (b) facilitated reinforcement- schedule thinning, and (c) prevented or mitigated relapse when caregivers did not deliver planned reinforcement for the FCR.9 In addition, our related preliminary research showed that mult FCT often: (a) rapidly reduced destructive behavior, (b) facilitated treatment transfer across contexts without evoking renewal, and (c) reduced the need for a punishment component. We will conduct a randomized clinical trial to compare the effectiveness of mult FCT to traditional FCT, which does not signal reinforcement availability and unavailability, for mitigating renewal, superresurgence, and reinstatement. We also will test whether mult FCT + stimulus fading, in which we conduct each context change in gradual steps, will further reduce treatment relapse. This novel project has the potential to change the way researchers and clinicians analyze and prevent treatment relapse, thereby markedly improving the long-term outcomes for children and families afflicted by these debilitating behavior disorders.

项目摘要 严重的破坏性行为代表了发育残疾的合并状况，风险 随着智力残疾的严重程度，沟通缺陷和同时发生的自闭症谱系的增加而增加 障碍。24,78破坏性行为，例如自我伤害行为和侵略性，对孩子造成伤害 和其他 79临床医生使用功能分析来确定变量 加强或激励破坏性行为并发展有效的，基于功能的治疗。4功能 沟通培训（FCT）是一种基于功能的经验支持，可降低破坏性的治疗 行为。临床教会孩子使用功能通信响应（FCR）要求 在FCT期间，有侵蚀行为的增强剂和破坏性行为正在扩展。6,39，例如，如果 功能分析结果表明，注意力增强了破坏性行为，临床医生将提供 当孩子使用FCR时（“请和我一起玩。”），并且不会引起破坏性的关注 行为。 FCT的一个局限性是继电器，最初有效后破坏性行为的增加 当我们将治疗转移给新的治疗师，看护人或设置或改变时，通常会发生治疗 代理商实施了错误。8,39,80,811个行为分析师将继电器描述为（a） 治疗时更新 上下文变化（例如，从诊所转移到家中），12（b）恢复FCR 当更新和复苏同时发生时产生增强型，82和超级责任 继电器的水平比单独的两个，14和（c）恢复生产的继电器水平。 提供加固 在计划外的时期。83基于行为的我们的研究。 动量理论表明，何时FCR会和不会在我们期间产生增强的信号 多组fct（多FCT）程序：（a）防止延伸爆发，（b）支撑的加固 - 时间表稀疏，（c）当护理人员未提供计划时，请阻止或减轻继电器 FCR.9的强化此外，我们相关的初步研究表明，Multi fct经常： （a）迅速降低破坏性行为，（b）跨环境中的促进治疗转移 唤起续约，（c）减少了对惩罚部分的需求。我们将进行随机临床 试验将多FCT与传统FCT的有效性进行比较，这不会表示强化 可用性和不可用，用于减轻续签，较高的和恢复原状。我们还将测试 多fct +刺激是否逐渐变化，是否会进一步改变等级步骤 减少治疗继电器。这个新颖的项目有可能改变研究人员和临床医生的方式 分析和防止治疗中继，从而明显改善儿童的长期结局和 受这些使人衰弱的行为障碍困扰的家庭。