Functional Communication Training Revisited

1. Functional Communication Training Revisited Enhancing Communication to Enhance Quality of Life Darlene Magito McLaughlin, Ph.D. Positive Behavior Support Consulting & Psychological Resources, P.C.

2. Introduction and Overview • The ability to communicate with others is a vital human skill that enables one to be an active participant in society and to exercise control over the environment.

3. Communication Breakdown • Acquisition • Fluency • Maintenance • Generalization

4. Barriers to Communication • Low expectations • Status quo • Lack of skill or knowledge from professionals • Lack of qualified personnel to assess and/or address communication challenges • Failure to keep up with emergent technology; lack of continuing education • Limitations of augmentative systems: expensive, non-transferable, lost, broken, difficulties programming

5. Barriers continued… • Staff turnover; lack of continuity • Limited carryover across environments (home-school-community) • Limited coordination between education, speech, psychology, and direct care staff • Limited data collection • Stigmatization

6. When Communication Breaks Down… • Often leads to severe problem behavior • Can prevent full community inclusion (home, school, employment) • Can frustrate family members, teachers, and support staff • Can increase the likelihood of restrictive settings and procedures (loss of dignity and choice)

7. When Communication Breaks Down… • Can lead to rejection by others (social isolation, lack of friends) • Can be damaging to self-esteem • Can alter quality of life

8. Background • Early on, behavior analysis focused on the form of behavior, and emphasized consequence-based strategies for increasing and decreasing behaviors • The arrival of functional analysis brought an increased recognition of the purposeful nature of behavior, setting the stage for a communication hypothesis

9. The Purposeful Nature of Behavior • Behaviors are not random, bizarre acts but, instead, are purposeful in nature • Classes of controlling variables • Medical • Escape • Attention • Tangibles • Sensory

10. Conceptual Base for a Communication Hypothesis • An inverse relationship exists between the frequency of behavior problems and the level of communicative skill that an individual possesses • Problem behaviors can be usefully viewed as a nonverbal form of communication • As an individual acquires more sophisticated forms of communication, primitive forms become less effective and either drop out or remain only minimally

11. Advantages of the Communication Model • Focuses on skill-building and educational considerations • Individuals can initiate interactions that eventually lead to preferred reinforcers (active role in treatment process) • Increased communication=Increased control • Control, in itself, may be a reinforcer (competence, mastery, etc.)

12. Assessment • Functional Analysis is used to identify purpose • Three-Stage Process: • Describe: Interview and direct observation • Categorize: Common themes and hypotheses • Verify: Confirm or disconfirm; consider setting events

13. Communication Hypothesis: Medical • Problem Behavior = “I’m not feeling well.” • Identify acute, recurrent, and chronic conditions • Pinpoint area of discomfort • Identify potential remedies

14. Communication Hypothesis: Escape • Problem Behavior = “I would like to take a break.” • Consider type of task (gross vs. fine motor) • Role of feedback • Speed of task (pace of instruction) • Novelty vs. repetition • Type of prompt (e.g., gestural vs. physical)

15. Communication Hypothesis: Attention • Problem behavior = “Hello” or “Excuse me.” • From whom (e.g., preferred vs. non-preferred person)? • Content (e.g., game vs. conversation) • When (e.g., bedtime vs. snack)?

16. Communication Hypothesis: Tangible or Sensory Reinforcement • Problem behavior = “I want…” or “I need…” • Specific item/activity? Or class of items/activities? • Negotiation (alternative, time and place) • Delayed gratification

17. Practical Applications: Part 1 • Rapport • Form vs. Function • Opportunity • Tolerance for Delay

18. Key Idea #1: Building Rapport • Rapport is an important consideration in functional communication training. The person receiving the training has to want to communicate with you! • Reasons why rapport might be poor • Little in common • Lack of communication • History of negative interactions

19. Assessment of Rapport • Participant: Choice behavior • Staff member: Subjective rating scale • Observers: Relative rankings

20. Building Rapport • Pair with positives • Responsivity (3A-Rule) • Reciprocity and turn-taking

21. Key Idea #2: Form vs. Function • Functional Equivalence • Modality: “My Favorite Thing” • Ease, Efficiency, and Interpretability • Durability and Portability • Vocabulary Selection • Preference Inventory • GeneralSpecific

22. Form vs. Function (continued) • Augmentative, Alternative, and Assistive Technology Systems • Daily Schedules • Embedded Schedules • “Super Symbols” • First-Then Boards • Activity Displays • Task Analyses • Turn-taking Boards

23. Key Idea #3: Opportunity • ACES: Analyzing the Communication Environment • Utilize information gathered during functional analysis • Reinforce communication during normal event sequences • Attend to requests at high rates. At the same time, make problem behavior inefficient.

24. Key Idea #4: Tolerance for Delay • Shaping: Independent Schedule • ContinuousIntermittent Schedules of SR+ • Fade staff prompting • Be flexible; may be necessary to go back • Teach discrimination by using natural cues • Use filled pauses • Handle “Breaks over” problem

25. Break/Question and Answer Period

26. Practical Applications: Part 2 • Mood/Embedding • Choice • Lasting change

27. Key Idea #5: Mood/Embedding • Works particularly well with escape-motivated problem behavior • Assessment of mood • Interaction effect between mood and demands • Reasons why mood might be poor

28. Mood/Embedding (continued) • Options for intervention • Eliminate events that are associated with bad mood • Eliminate demands • Embed demands within a positive context

29. Key Idea #6: Choice • Increase opportunities for an individual to influence the environment in a socially appropriate manner through shared control with the treatment agent • Choose what task, with whom, what reinforcers, etc.

30. Key Idea #7: Lasting Change • Begin in a controlled setting; move to a less controlled one • Train natural supports across all relevant settings • Move toward systems change • Variations in routine, variety, flexibility, etc. • Incentives for staff

31. Individual Applications • Case Examples • FCT • Mood • Rapport

32. To Do List… • Identify the need for assistance • Conduct a functional and/or environmental analysis • Develop a communication plan • Train relevant staff • Implement the plan • Monitor success • Troubleshoot, if necessary

33. Communication and Quality of Life • Relationships • Community • Choice • Skills • Respected Roles

34. Conclusions • Decision Control, Before and Now • Communication plays an integral part in quality of life enhancement

35. Wrap Up/Question and Answer Period