Functional Behavior Assessments for Challenging Behavior in Autism
Functional behavioral assessment (FBA) is a behavioral technology for identifying variables that control target behaviors. FBA has provided a major contribution to clinical intervention for persons with developmental disabilities who present with challenging behavior. It has improved the efficacy of behavioral intervention by ensuring function-based treatment and ongoing review of treatment outcomes. Persons with developmental disabilities are at high risk for the development of challenging behavior, and this in turn can lead to a myriad of additional problems including psychiatric disorder, social deficits, and reduced quality of life. Given the value of FBA in considerably improving the efficiency of clinical interventions for people with challenging behavior, it is imperative that such individuals receive behavioral treatments that are function based. This can only be achieved by increasing staff training in the many variations of FBA and ensuring that all persons with developmental disabilities who evince challenging behavior are entitled to such assessment.
This paper will outline each of the different methodologies of FBA in clinical and educational practice and will provide a comparison of the outcomes from each methodology. The importance of the technology at identifying controlling variables for challenging behavior and the effectiveness with producing substantive change in the lives of people with challenging behavior will be discussed.
Functional behavior assessment (FBA) is defined as a process of identifying the events in the environment that consistently precede and follow challenging behavior in persons with developmental disabilities. Total population studies carried out in Britain, the USA, and Scandinavia indicate that 10–15 % of people with developmental disabilities engage in one or more forms of challenging behavior (Emerson E, et al. Res Dev Disabil 22:67–75, 2001; Holden B, Gitleson JP. Res Dev Disabil 27:456–465, 2006; McClintock K, et al. J Intellect Disabil Res 47:405–416, 2003). Topographies of challenging behavior can range from self-injurious behavior, aggression, stereotyped behavior, and destructive/disruptive behavior. The topography of a given behavior may not adequately reflect the complexity of etiology and assessment (Matson JL, Nebel-Schwalm MS. Res Dev Disabil 28:341–352, 2007). The presence of challenging behavior can impact on an individual’s quality of life by impeding their access to a variety of everyday activities, socialization opportunities, and many other learning opportunities (Luiselli JK, et al. J Behav Ther Exp Psychiatry 31:219–230, 2000). Given the prevalence of challenging behavior in individuals with autism (e.g., Fox RA, et al. Res Dev Disabil 28:119–129, 2007; Murphy O, et al. Res Autism Spect Dis 3:474–482, 2009), it is vital that an adequate means of behavioral assessment for challenging behaviors is available to clinicians and caregivers. Such behavioral assessment can positively affect the course of intervention that follows for vulnerable populations.
FBA can be divided into three areas: (a) indirect methods involving the use of interviews, rating scales, checklists, and questionnaires; (b) direct methods using observation or descriptive analysis, incorporating antecedent-behavior-consequence recording, and scatterplots; and (c) experimental methods more commonly known as functional analyses or analog assessment (Neilsen SL, McEvoy MA. J Early Intervent 26:115–131, 2004). FBA procedures have been hailed as the most exciting and sophisticated research literature in the field of applied behavior analysis (Halle JW, Spradlin JE. Identifying stimulus control of challenging behavior: extending the analysis. In: Reichle J, Wacker D, editors. Communicative alternatives to challenging behavior: integrating functional assessment and intervention strategies Baltimore: Paul Brookes; 1993. p. 83–109; Mace FC. J Appl Behav Anal 27:385–392, 1994). Much of the research published on FBA methodologies has focused on individuals with developmental disabilities who present with challenging behavior that can seriously limit or deny access to the use of ordinary community facilities and be a danger to oneself and others. Furthermore, FBA has a history of being implemented for cases of very challenging behavior often exhibited by persons with severe disabilities. The term “challenging behavior” is often used invariably by clinicians and researchers with terms such as “maladaptive behavior,” “behavior problems,” “problem behavior,” and “aberrant behavior” (McClintock K, et al. J Intellect Disabil Res 47:405–416, 2003).
The purpose of functional assessment is to provide a thorough investigation of the purpose of the problematic behavior prior to the design of behavioral intervention. Precise and careful analysis of the behavior through the use of questionnaires, interviews, rating scales, and direct observations can be combined to form hypotheses associated with the reasons why a particular behavior might be repeatedly emitted by an individual. According to Matson et al. (National Assoc Dual Diagn Newsl 5:19–21, 2002), “without an adequate assessment, treatment selection may be absent or inappropriate. Unfortunately, medications and psychological interventions are often initiated and then changed repeatedly due to a lack of diagnostic information. The assessment process should be separated into diagnosis, functional assessment, establishment of replacement behaviors, evaluation of treatment effects, and evaluation of treatment side-effects. This approach will increase the likelihood that an appropriate link is made between assessment and treatment, and assist with the monitoring of treatment effectiveness” (p. 19).
This review of functional behavior assessment in autism and developmental disabilities will outline each of the different methodologies under the headings of indirect methods and direct methods. A discussion of experimental functional assessment methods, as the recommended progression for using functional behavioral assessment methodologies in clinical and educational practice, will also be provided. Finally, a comparison of the outcomes of the different types of methodologies will be presented.
KeywordsFunctional Behavior Assessment Challenging Behavior Developmental Disabilities Behavioral Problems Experimental Functional Analysis (EFA)
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