Moving Beyond ABA: How to do a Functional Analysis…

#Ooh Ooh Ooh! They Finally Did It!

“In all my years of doing Functional Analysis and treating problem behavior, I have never once, not once, been thanked by a parent for effecting a long-lasting, socially relevant change. None of them have been able to tell me I long-term changed their children’s lives for the better” – Greg Hanley, BCBA-D, Ph.D.

I recently went to a conference about critical issues impacting children and adolescents. I was hopefully optimistic that because the conference was in Utah there would not be too strong a focus on Applied Behavioral Analysis (ABA) as a primary treatment measure for autism.

Alas, I was slightly disappointed when I saw the presenter information and noticed Greg Hanley, Ph.D., BCBA-D was the keynote speaker and teaching all the sessions I was interested in. Anyone following this blog knows I do not put much stock in ABA as a science, which means I have a particular disdain for a rather large proportion of the methods used in ABA and have not shied away from being vocal about it. However, in speaking with my colleagues in the district office that are working toward their BCBA, I found out Dr. Hanley has a “unique and somewhat controversial approach” to functional analyses and the treatment of problematic and dangerous behaviors in autism, and that they were interested to see the “other side” of the debate among BCBA regarding treatment methods.

As a scientist and teacher, I do try to keep an open mind and I try very hard to give everyone the benefit of the doubt, so I took a deep breath, left my prejudice at the door (mostly), and focused on the science of what was being presented. All that being said, I am ecstatic I attended the conference as well as the fact I attended all of Dr. Hanley’s presentations. I enjoyed the presentations immensely and I left hopeful that the methods being used in ABA-based therapy are starting to evolve and treatments are becoming more humane – or at least some precedent is being laid down to justify such a movement.

I will refer the reader to the following links to get information about Dr. Hanley’s works I am speaking about. The first is his website outlining his methods. Under the presentations tab if you look at November 2-5, 2016 there are the powerpoints and handouts from the conference I attended. Relevant papers can be downloaded Here and Here (please contact me if you cannot get these or any articles I link to in this post, I have them and am very happy to share the science).


What is a “standard” Functional Analysis?

Before I dive further in, I do not mean to infer that all functional analyses are standardized tests. They aren’t. I use the term “standard” functional analysis in the same way Dr. Hanley does in his manuscripts. This means any functional analysis that isolates attention, escape, or tangibles as motivators will be referred as a “standard” functional analysis.

Rather than try to give an explanation of a functional analysis, I will give a pseudo-textbook definition and then explain quickly what it means. I leave deeper conversations regarding functional analyses, their validity, and methodology to others.

From Wikipedia:

A functional analysis is the most direct form of functional behavior assessment, in which specific antecedents and consequences are systematically manipulated to test their separate effects on the behavior of interest. Each manipulation of the antecedent and consequence in a particular situation is referred to a condition. In a functional analysis, conditions are typically alternated between quite rapidly independent of responding to test the different functions of behavior. When data paths are elevated above the control condition (described below) it can be said that there is a functional relation between that condition and the behavior of interest. Below, common examples of experimental conditions are described. A standard functional analysis normally has four conditions (three test conditions and one control):

Attention

In this condition, the experimenter gives the individual moderately preferred items and instructs them to go play. After that initial instruction, the experimenter pretends to act busy and ignores all bids for attention from the individual. If the individual engages in the behavior of interest, the experimenter provides the individual with attention (commonly in the form of a reprimand). Behaviors that occur more frequently in this condition can be said to be attention maintained.

Escape/Avoid

In this condition, the experimenter instructs the individual that it is time to work. After the initial instruction, the experimenter delivers a series of demands that the individual is typically required to complete (e.g. math problems, cleaning up, etc.). If the individual engages in the behavior of interest, the demand is removed and the child is allowed to take a break. Behaviors that occur more frequently in this condition can be said to be escape maintained.

Alone

Normally referred to as tangible condition. In this condition, the child is left alone with a variety of items to engage with. If the child engages in the behavior of interest, no programmed consequences are delivered. Behaviors that occur more frequently in this condition can be said to be automatically maintained.

Control (play)

In this condition, the child is allowed to engage with a variety of items during the session. No demands are placed on the child throughout the duration of the session. The experimenter provides attention to the individual throughout the session on any behavior that is not the target behavior. If the target behavior occurs, the experimenter removes attention until the behavior has subsided. This session is meant to act as a control condition, meaning that the environment is enriched for the purpose of the behavior not occurring. Said another way, by meeting environmental needs for all possible functions, the individual is not likely to engage in the behavior of interest. This condition is used as a comparison to the other conditions. Any condition that is elevated to a large degree form the control condition, shows a higher degree experimental control indicating the functional relationship between the specific environmental conditions and the behavior of interest.

In essence, a functional analysis is an experiment. The researcher, teacher, or behavioral analyst forms a hypothesis regarding the function of the behavior – or why the child engages in a certain behavior. They then place the child in a controlled environment and test their assumptions by repeatedly offering the child challenges by removing what they hypothesize the child wants and recording the responses. To preserve experimental replicability, the tangibles used in a standard analysis are held relatively constant across functional analyses, as are the escape and attention contingencies (where to escape and/or scripted attention).

The standard functional analysis can take hundreds of trials and takes a significant amount of time. If everything goes as predicted, the child will respond with a behavior when the experimenter removes the hypothesized contingency (attention, escape, or tangible), whereas removing the other contingencies will not result in similar flare-ups of behaviors. The standard functional analysis also interspersed free-play conditions they consider a control or no task condition. This differential effect is called “differentiation” and is the hallmark result of a behavioral analysis.

What is this new thing I am talking about (IISCA)?

What Dr. Hanley proposed in 2014 was a new way to perform a functional analysis. The quote I started this post with was what Dr. Hanley said as his motivation for changing how he does his functional analyses. He spent decades performing standard functional analyses and designing behavioral treatments based on the results of those analyses.

In his presentations, Dr. Hanley belabored a point I agree with entirely. He suggested it as a motivation for developing the IISCA and relying on open-ended rather than standardized interviews.

[F]rom a clinician perspective, it does not matter whether or not we can characterize the function of a behavior; just so long as we can identify the topography of the behavior and use our identified synthesized contingencies to turn the behavior on and off. If we can do that, then we can help the child or young adult. We get too bound up as BCBA and ABA therapists on characterizing the behavior that we forget that our goal is to help the child overcome problematic or dangerous behaviors. We get too bound up in positive and negative reinforcements and other definitions that we lose sight of our mission.

IISCA stands for Interview-Informed Synthesized Contingency Analysis. They chose to go with the clumsy acronym IISCA because it captures two procedural differences between this method and the traditional, “standard” functional analyses. The first is that the specific contingencies (and combinations thereof) assessed and materials used in the sessions are derived from the interviews, thus the analysis is interview informed rather than experimenter driven.

The first part of the IISCA is the open-ended interview (you can download the actual template here). This is important for two reasons: First, checklists like those commonly used by BCBA to interview parents tend to limit responses to multiple choices and thus can actually guide responses rather than allow parents or caretakers to report their experiences. And B, open-ended questionnaires take a lot less time to perform. Often, the checklist questionnaires take 60-90 minutes to perform, whereas the open-ended interviews take 30 minutes. Sometimes, parents even take the forms home, talk to their family, and return it at their leisure.

The second part that I will emphasize for the IISCA, and why I like it as a method, is that it accepts that reality is complicated. What I mean is that I have never met a child misbehaving for something as simple as “attention” or “escape”. I have never seen a student try to get out of doing work and being contented with fleeing from work to a corner of the room to do nothing. I also have never seen students seek any attention I am willing to give. They want a certain type of attention. Ditto for a tangible. Only rarely do children respond to any tangible-they prefer certain ones over others.

The IISCA method emphasizes the use of so-called “synthesized contingencies”. By “synthesized contingency”, Dr. Hanley (and I) is referring to the phenomenon that children tend to escape from tasks to play with toys while seeking attention from a preferred adult (i.e.,  escape to attention + tangible). Some children escape to predictability (i.e., they flee from unpredictability or transition to force the typical schedule). Others are rewarded by what is called “mand compliance”, or having adults comply with verbal demands. This is clearly a form of attention seeking, but it is qualitatively different enough that it needs its own category. Interestingly, in his presentations Dr. Hanlkey makes a point I agree with entirely:

The IISCA procedure also emphasizes using the specific reinforcers that the child responds maximally to. Oftentimes, they use whatever stimuli the parents bring with the child. The assumption is that there is a reason why the family brought those items: that reason is that those items sooth and calm the child.

Also, the IISCA emphasizes focusing on what are called precursor behaviors to the major problem behaviors. In other words, if a child always growls or yells prior to physically aggressing, then the experimenter or analysis terminates trials when the child growls or yells, rather than waiting until they engage in physical aggression.

Of interest is that the average IISCA takes approximately 30 minutes for the open-ended interview and then 30 minutes for the functional analysis. There are three 5-minute control sessions wherein the child is given access to reinforcers (even if that is adult attention, iPad, etc) regardless their behaviors. There are then three 5-minute sessions wherein the child is given demands and separated from the reinforcers. Once the child shows precursor behaviors the reinforcement is returned and the data are taken. Since the IISCA is only evaluating the synthesized contingency, there are only 2 conditions (control, experiment) and if there is differentiation, the IISCA is finished quickly (in one report Dr. Hanley suggests an IISCA can be performed in 5 minutes).

Another cool part with the IISCA, it has been shown to be easy enough a protocol that parents and teachers can replicate the findings of the experimenters, with only minimal training and assistance through Skype (manuscript here).

Is the IISCA really better?

Yes. Much better. In pretty much every way you can imagine.

I say this because the treatment informed by the IISCA is functional communication training (FCT). This means training the child to use communication to get reinforcement rather than using misbehavior to fulfill needs. Based on the literature, using the information obtained from the IISCA results in faster, more efficient, and longer lasting FCT than using information obtained through a standard functional analysis.  Below is a figure from a Master’s thesis showing that treatment based on standard functional assessments are much less reliable than those informed by an IISCA.

Basically, what this shows is that the kids are much more willing to use FCT to get their needs met if they are offered the entire reward (i.e., the synthesized contingency) rather than isolated attention, escape, or access to a tangible. They can even be taught to tolerate being told, “No” and tolerate rather long delays before receiving rewards because the reward is so salient when it is finally presented.

Conclusion

Overall, I am excited to see this new direction in the ABA community and I hope it will be implemented in the larger ABA community. For my part, I have already used the IISCA method twice this month and it works. It is basically the method I was using before to “figure out what is making this kid tick” as I put it, but it is nice to finally have a formalized method to follow so I do not have to keep justifying my methods that always appear at odds with what other people are doing. I can vouch for the rapidity of the method and the validity of the data. The kids also seem to have much more fun during this type of functional analysis compared to the standard functional analysis.

In my opinion, although Dr. Hanley’s ideas are new and novel, we can and should begin to use them in schools to help our kiddos overcome behavioral challenges to access their education. This will improve these students’ quality of life greatly, and in the end that is all we are after.

 

 

Beyond Mainstreaming, How to Best Expand the Horizons of Special Education Students

Ooh Ooh Ooh, They Finally Did It!

I am not entirely sure if it is they finally did it or I finally did it for this post. I have been working this year as a half-time Resource teacher in one elementary school and as a half-time mainstreaming facilitator across two schools (actually, it was supposed to be at one school, but I couldn’t help myself).

Part of that plan I talked about earlier in my Mainstream Decision Tree post, and I appreciate all the feedback I received on that plan and I am happy to report it was very successful in implementation.

When I was hired, my supervisors told me I was part of an ambitious plan, and they hoped we would be able to do great things. Later, I found out I was given the position because I was so adamant about the importance of collecting data so we can release students from special education services once they no longer needed them, so we did not doom these students to a life of low expectation.

This year, I worked to develop a process to get relatively high performing special education students out of a full-time special education classroom and into the general education classroom with as little special education services as the student needed to be successful.  I will detail the process below and link to an academic paper I am writing on the topic to solicit feedback.

What Have I Been Up To?

This has definitely been a year of experimentation and risk taking! Scientifically it has been the most intense time in my career, and I am not even in academic science anymore! My days have been writing behavior plans, implementing them, training personnel (both teachers and paraeducators), and collecting data. I have used each and every one of my data sheets from my Behavioral First Aid Kit in one way or another.

The result of these experiments and chances are two documents I call a Mainstreaming Decision Tree and a Mainstreaming Pipeline that I use to guide students through the process of transitioning from a special education self-contained classroom to a general education classroom environment. The technical term for this process is Transenvironmental Programming and has been advocated for decades now by Fuchs and colleagues at Vanderbilt (Link to Lynn Fuchs Google Scholar Page).

How do I Identify a Candidate for Transition?

I have previously talked about how to identify potential candidates for transition out of a self-contained classroom in a previous post. What I settled on was that we often make the mistake of using IQ scores as a premium and neglect other neuropsychological data we often see in a special education file.

To that end, I developed a Mainstream Decision Tree that lets me make decisions by relying on data that each student should have in their file already. Based on research from colleagues of mine in academia studying neurodevelopmental disorders, I decided on a hierarchy of measures. Their adaptive function was first, followed by full-scale IQ (verbal or nonverbal tests are okay here), academic achievement, and finally behavioral/social/emotional health.

The result of this decision-making process was a starting point for inclusion or mainstreaming. It was a prediction for where the student would be successful if moved to a general education classroom at that precise moment in time without any prior preparation. Preparation and support would then be provided to help students move toward independent access to the general education class full time.

The final Mainstreaming Decision Tree is below.

MainstreamDecisionTree

The Process Itself

I will distill my process to 7 steps below (in simplified bullet point form, you can read the attached pdf for a more comprehensive description of each step.

  • Identify Candidate Students. This step is using the Mainstreaming Decision Tree described above. I looked at the special education feels for each student and waded through the chaff to find information that is relevant for student success. I wrote that down and created a data matrix. I take these successes and start calling parents for permission and signatures to move forward with transitioning their students. Most parents were elated I was showing faith in their students. Others, not so much: but I was able to convince them in the end.
  • Identify Classroom Placements. This step involved me looking at the grade level teachers and deciding which were a great fit for each of the students identified as candidates for transition. Unfortunately, I relied upon the traditions within the schools o tell me whom to choose. So I overburdened a few teachers and left the rest of the school relatively unaffected by my experiment. I feel bad about this, so I am going to try and spread the students around a little better next year and not focus on only 1 class per grade level, but rather 2 or 3.
  • Classroom Ecological Inventory. When classrooms have been identified, I go in and answer a number of questions about how that class is run and what are the expectations. I do the same with the special education class and the two are compared. Then solutions are developed to minimize these differences and make special education and general education classes as similar as possible. I developed this questionnaire on the fly during the year, so only now at the end do I have a version I am happy with, so I made it into a Google Form that I can use for a number of different purposes (it is at the bottom of this post in case any of you are teachers and want to chime in on how your classroom looks).
  • Initiate student placement in a mainstream general education classroom. At this point, I moved the student into the general education class for 50% of the day. I wish I could have done it during the subject that was the student’s strength, but I was only at this school in the morning, so that was when the students started their mainstreaming. This was an unfortunate artifact of my schedule. Next year we will start with the student’s strengths and slowly phase in time in their weaker subjects.

  • The transition from part-time to full-time general education mainstreaming (with or without part-time Resource support). As the students show success, they are given more time in the general education classroom. They are also given time in the Resource classroom as appropriate to fill academic gaps. I favor this system over receiving instruction in the self-contained classes since Resource pull outs also contain peers from the class and tend to be at a higher academic level than the special classes.

  • The formal transition from special education to general education. This is the scary IEP meeting. I moved the students from receiving 6.5 hours of special education services a day to receiving from 15 minutes to 1.5 hours of special educations services as the students needed. These services included time with the speech-language pathologist, social workers, and Resource pull outs. I am not averse to 3+ hours of Resource time (self-contained Resource), but none of my students required this level of special education.

  • The transition from unit school to the neighborhood school. These are end-of-year meetings with the geographical neighborhood school these students will attend the next year. These meetings let me explain the skills, successes, and challenges each student has with the IEP team at the school the student will attend. This lets the student hit the ground running the next year.

So How Did the Grand Experiment Go?

Overall, I consider this year a resounding success!

Of 62 students I was working with across 3 classrooms, 20 were selected as candidates for transition based on the Mainstream Decision Tree. Ten (10) of these students had a special education classification of Autism, 6 had a classification of Specific Learning Disability, 1 a classification of Emotional Disturbance, 1 of Speech and Language Impairment, and 1 a classification of Other Health Impairment.

Overall, this year 9 of the 20 candidates were able to successfully access the general education classroom independently. So we worked with their parents to transition them into a general education placement with only the amount of special education that was necessary to ensure student mainstream, success. Two (2) more students will make this transition early next year, making for 11/20 transitioned students (or 65% of identified candidates). The other students need additional access to the self-contained classroom to show academic and behavioral success in a general education classroom.

For these 9 students that transitioned this year, they went from having 6.5 hours a day or special education services in a self-contained special classroom, to receiving between 15 and 90 minutes (1.5 hours) of special education services. Even better, 3 of these students approached me and demanded that they would be given access to the general education classroom full time. They said they were ready and wanted it. So I obliged happily.

So far, from what I gather when these former full-time special education students approach me and chat, these students are happy with their change. They were ready. They just needed some sort of an advocate to give them the chance at success.

So What About Next Year?

Next year, I will be doing the same thing I did this year half-time, but  full-time. I will be working with 8 academic self-contained special education special classrooms working to help their students access the general education curriculum.

I hope my methods piloted out this year serve me well next year in different schools with different cultures.

My Ideas Worked, So I Wrote an Academic paper, Because of Course I Did!

If you want more information on what I did this year, please click on this link to download a formatted pdf of the manuscript. If you are so inclined, I welcome and am in fact soliciting peer review of this write-up so I can make any necessary changes before I submit it to an academic journal this summer. Feel free to submit any feedback in the comment section below or to my email at whyhaventtheydonethatyet@gmail.com.

Finally, I made my Classroom Ecological Inventory as a Google Form. I want to get as much data as I can from both special education and general education teachers. I want to be able to use data to develop a set of pre-designed interventions that can be used to normalize the special education and general education environments. Therefore, if you are a Kindergarten through 6th-grade teacher (or if you ever were), please fill out this quick survey so I can use data to start developing new data-driven methods.