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Functional Communication Training for Adults with Autism Spectrum Disorder: A Systematic Review and Quality Appraisal

Abstract

Functional communication training (FCT) is one of the most common treatments for challenging behavior and is considered an empirically supported practice for children and adolescents with autism spectrum disorder (ASD). However, no previous systematic review has evaluated the quality of FCT for adults with ASD, and the empirical support for this practice among adults is unknown. The purpose of the current review was to synthesize the extant research, including a quality appraisal of the literature on the use of FCT to treat challenging behavior for adults with ASD. We identified 20 studies that evaluated the efficacy of FCT in reducing challenging behavior for adults with ASD. The quality of each article was evaluated based on the What Works Clearinghouse design and evidence standards. Following the quality and evidence evaluations, eight studies, including eight experiments, were found to have moderate or strong evidence of effectiveness. The current body of literature provides some evidence for the efficacy of FCT in reducing challenging behavior for adults with ASD, but additional research in this area is warranted.

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References

  1. References marked with an asterisk indicate studies included in the review.

  2. *Adami, S., Falcomata, T. S., Muething, C. S., & Hoffman, K. (2017). An evaluation of lag schedules of reinforcement during functional communication training: Effects on varied mand responding and challenging behavior. Behavior Analysis in Practice. https://doi.org/10.1007/s40617-017-0179-7.

  3. Andzik, N. R., Cannella-Malone, H. I., & Sigafoos, J. (2016). Practitioner-implemented functional communication training: A review of the literature. Research and Practice for Persons with Severe Disabilities, 41(2), 79–89. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=eric&AN=EJ1099223&site=ehost-live

  4. *Bird, F., Dores, P. A., Moniz, D., & Robinson, J. (1989). Reducing severe aggressive and self-injurious behaviors with functional communication training. American Journal on Mental Retardation,94(1), 37–48.

  5. *Byiers, B. J., Dimian, A., & Symons, F. J. (2014). Functional communication training in Rett syndrome: A preliminary study. American Journal on Intellectual and Developmental Disabilities,119(4), 340–350. https://doi.org/10.1352/1944-7558-119.4.34.

  6. *Campos, C., Leon, Y., Sleiman, A., & Urcuyo, B. (2017). Further evaluation of the use of multiple schedules for behavior maintained by negative reinforcement. Behavior Modification,41(2), 269–285. https://doi.org/10.1177/0145445516670838.

  7. Carr, E. G., & Durand, V. M. (1985). Reducing behavior problems through functional communication training. Journal of Applied Behavior Analysis,18(2), 111–126. https://doi.org/10.1901/jaba.1985.18-111.

  8. *Chezan, L. C., Drasgow, E., & Martin, C. A. (2014). Discrete-trial functional analysis and functional communication training with three adults with intellectual disabilities and problem behavior. Journal of Behavioral Education,23(2), 221–246. https://doi.org/10.1007/s10864-013-9192-2.

  9. Chezan, L. C., Wolfe, K., & Drasgow, E. (2018). A meta-analysis of functional communication training effects on problem behavior and alternative communicative responses. Focus on Autism and Other Developmental Disabilities,33(4), 195–205. https://doi.org/10.1177/1088357617741294.

  10. Cooper, J. O., Heron, T. E., & Heward, W. L. (2007). Applied behavior analysis (2nd ed.). Upper Saddle River: Pearson.

  11. Emerson, E., Robertson, J., Gregory, N., Hatton, C., Kessissoglou, S., Hallam, A., et al. (2000). Treatment and management of challenging behaviours in residential settings. Journal of Applied Research in Intellectual Disabilities,13(4), 197–215. https://doi.org/10.1046/j.1468-3148.2000.00036.x.

  12. *Fahmie, T. A., Iwata, B. A., & Mead, S. C. (2016). Within-subject analysis of a prevention strategy for problem behavior. Journal of Applied Behavior Analysis,49(4), 915–926. https://doi.org/10.1002/jaba.343.

  13. Falcomata, T. S., & Wacker, D. P. (2013). On the use of strategies for programming generalization during functional communication training: A review of the literature. Journal of Developmental and Physical Disabilities,25(1), 5–15. https://doi.org/10.1007/s10882-012-9311-3.

  14. Fisher, W. W., Greer, B. D., Romani, P. W., Zangrillo, A. N., & Owen, T. M. (2016). Comparisons of synthesized and individual reinforcement contingencies during functional analysis. Journal of Applied Behavior Analysis,49(3), 596–616. https://doi.org/10.1002/jaba.314.

  15. *Fisher, W. W., Thompson, R. H., Hagopian, L. P., Bowman, L. G., & Krug, A. (2000). Facilitating tolerance of delayed reinforcement during functional communication training. Behavior Modification,24(1), 3–29. https://doi.org/10.1177/0145445500241001.

  16. Gerber, F., Bessero, S., Robbiani, B., Courvoisier, D. S., Baud, M. A., Traore, M., et al. (2011). Comparing residential programmes for adults with autism spectrum disorders and intellectual disability: Outcomes of challenging behaviour and quality of life. Journal of Intellectual Disability Research,55(9), 918–932. https://doi.org/10.1111/j.1365-2788.2011.01455.x.

  17. Gerhardt, P. F., & Lainer, I. (2011). Addressing the needs of adolescents and adults with autism: A crisis on the horizon. Journal of Contemporary Psychotherapy,41(1), 37–45. https://doi.org/10.1007/s10879-010-9460-2.

  18. Gerow, S., Davis, T., Radhakrishnan, S., Gregori, E., & Rivera, G. (2018a). Functional communication training: The strength of evidence across disabilities. Exceptional Children. https://doi.org/10.1177/0014402918793399.

  19. Gerow, S., Hagan-Burke, S., Rispoli, M., Gregori, E., Mason, R., & Ninci, J. (2018b). A systematic review of parent-implemented functional communication training for children with ASD. Behavior Modification,42(3), 335–363. https://doi.org/10.1177/0145445517740872.

  20. *Ghaemmaghami, M., Hanley, G. P., & Jessel, J. (2016). Contingencies promote delay tolerance. Journal of Applied Behavior Analysis,49(3), 548–575. https://doi.org/10.1002/jaba.333.

  21. Hanley, G. P., Jin, C. S., Vanselow, N. R., & Hanratty, L. A. (2014). Producing meaningful improvements in problem behavior of children with autism via synthesized analyses and treatments. Journal of Applied Behavior Analysis,47(1), 16–36. https://doi.org/10.1002/jaba.106.

  22. Heath, A. K., Ganz, J. B., Parker, R., Burke, M., & Ninci, J. (2015). A meta-analytic review of functional communication training across mode of communication, age, and disability. Review Journal of Autism and Developmental Disorders,2(2), 155–166. https://doi.org/10.1007/s40489-014-0044-3.

  23. Holden, B., & Gitlesen, J. P. (2006). A total population study of challenging behaviour in the county of Hedmark, Norway: Prevalence, and risk markers. Research in Developmental Disabilities,27(4), 456–465. https://doi.org/10.1016/j.ridd.2005.06.001.

  24. Hong, E. R., Ganz, J. B., Neely, L., Gerow, S., & Ninci, J. (2016). A review of the quality of primary caregiver-implemented communication intervention research for children with ASD. Research in Autism Spectrum Disorders,25, 122–136. https://doi.org/10.1016/j.rasd.2016.02.005.

  25. *Horner, R. H., & Day, H. M. (1991). The effects of response efficiency on functionally equivalent competing behaviors. Journal of Applied Behavior Analysis,24(4), 719–732. https://doi.org/10.1901/jaba.1991.24-719.

  26. Howlin, P., & Moss, P. (2012). Adults with autism spectrum disorders. The Canadian Journal of Psychiatry/La Revue Canadienne De Psychiatrie,57(5), 275–283. https://doi.org/10.1177/070674371205700502.

  27. Iwata, B. A., Dorsey, M. F., Slifer, K. J., Bauman, K. E., & Richman, G. S. (1994). Toward a functional analysis of self-injury. Journal of Applied Behavior Analysis,27(2), 197–209. https://doi.org/10.1901/jaba.1994.27-197.

  28. *Jensen, C. C., Mcconnachie, G., & Pierson, T. (2001). Long-term multicomponent intervention to reduce severe problem behavior: A 63-month evaluation. Journal of Positive Behavior Interventions,3(4), 225–236. https://doi.org/10.1177/109830070100300404.

  29. Kratochwill, T. R., Hitchcock, J. H., Horner, R. H., Levin, J. R., Odom, S. L., Rindskopf, D. M., & Shadish, W. R. (2013). Single-case intervention research design standards. Remedial and Special Education, 34, 26–38. https://doi.org/10.1177/0741932512452794.

  30. *Kunnavatana, S. S., Bloom, S. E., Samaha, A. L., Slocum, T. A., & Clay, C. J. (2018a). Manipulating parameters of reinforcement to reduce problem behavior without extinction. Journal of Applied Behavior Analysis,51(2), 283–302. https://doi.org/10.1002/jaba.443.

  31. *Kunnavatana, S. S., Wolfe, K., & Aguilar, A. N. (2018b). Assessing mand topography preference when developing a functional communication training intervention. Behavior Modification,42(3), 364–381. https://doi.org/10.1177/0145445517751437.

  32. *Langdon, N. A., Carr, E. G., & Owen-DeSchryver, J. S. (2008). Functional analysis of precursors for serious problem behavior and related intervention. Behavior Modification,32(6), 804–827. https://doi.org/10.1177/0145445508317943.

  33. *Lehardy, R. K., Lerman, D. C., Evans, L. M., O’Connor, A., & LeSage, D. L. (2013). A simplified methodology for identifying the function of elopement. Journal of Applied Behavior Analysis,46(1), 256–270. https://doi.org/10.1002/jaba.22.

  34. *Lindauer, S. E., Zarcone, J. R., Richman, D. M., & Schroeder, S. R. (2002). A comparison of multiple reinforcer assessments to identify the function of maladaptive behavior. Journal of Applied Behavior Analysis,35(3), 299–303. https://doi.org/10.1901/jaba.2002.35-299.

  35. Maggin, D. M., Briesch, A. M., & Chafouleas, S. M. (2013). An application of the What works clearinghouse standards for evaluating single-subject research: Synthesis of the self-management literature base. Remedial and Special Education,34(1), 44–58. https://doi.org/10.1177/0741932511435176.

  36. Manente, C. J., Maraventano, J. C., LaRue, R. H., Delmolino, L., & Sloan, D. (2010). Effective behavioral intervention for adults on the autism spectrum: Best practices in functional assessment and treatment development. Behavior Analyst Today,11(1), 36–48. https://doi.org/10.1037/h0100687.

  37. Matson, J. L., & Rivet, T. T. (2008). Characteristics of challenging behaviours in adults with autistic disorder, PDD-NOS, and intellectual disability. Journal of Intellectual and Developmental Disability,33(4), 323–329. https://doi.org/10.1080/13668250802492600.

  38. McClintock, K., Hall, S., & Oliver, C. (2003). Risk markers associated with challenging behaviours in people with intellectual disabilities: A meta-analytic study. Journal of Intellectual Disability Research,47(6), 405–416. https://doi.org/10.1046/j.1365-2788.2003.00517.x.

  39. Mills, S., & Rose, J. (2011). The relationship between challenging behaviour, burnout and cognitive variables in staff working with people who have intellectual disabilities. Journal of Intellectual Disability Research,55(9), 844–857. https://doi.org/10.1111/j.1365-2788.2011.01438.x.

  40. Neely, L., Garcia, E., Bankston, B., & Green, A. (2018). Generalization and maintenance of functional communication training for individuals with developmental disabilities: A systematic and quality review. Research in Developmental Disabilities. https://doi.org/10.1016/j.ridd.2018.02.002.

  41. *Petursson, P. I., & Eldevik, S. (2018). Functional analysis and communication training to reduce problem behavior and time in restraint: A case study. Behavior Analysis: Research and Practice. https://doi.org/10.1037/bar0000139.

  42. *Rehfeldt, R. A., & Chambers, M. R. (2003). Functional analysis and treatment of verbal perseverations displayed by an adult with autism. Journal of Applied Behavior Analysis,36(2), 259–261. https://doi.org/10.1901/jaba.2003.36-259.

  43. *Sigafoos, J., & Tucker, M. (2000). Brief assessment and treatment of multiple challenging behaviors. Behavioral Interventions,15(1), 53–70. https://doi.org/10.1002/(SICI)1099-078X(200001/03)15:1%3c53:AID-BIN43%3e3.0.CO;2-V.

  44. *Slaton, J. D., Hanley, G. P., & Raftery, K. J. (2017). Interview-informed functional analyses: A comparison of synthesized and isolated components. Journal of Applied Behavior Analysis,50(2), 252–277. https://doi.org/10.1002/jaba.384.

  45. Sullivan, R. C. (2007). Position paper on the national crisis in adult services for individuals with autism: A call to action (pp. 1–16). Bethesda: Autism Society of America.

  46. Tiger, J. H., Hanley, G. P., & Bruzek, J. (2008). Functional communication training: A review and practical guide. Behavior Analysis in Practice,1(1), 16–23. https://doi.org/10.1007/BF03391716.

  47. *Tincani, M. J., Castrogiavanni, A., & Axelrod, S. (1999). A comparison of the effectiveness of brief versus traditional functional analyses. Research in Developmental Disabilities,20(5), 327–338. https://doi.org/10.1016/S0891-4222(99)00014-1.

  48. Turcotte, P., Mathew, M., Shea, L. L., Brusilovskiy, E., & Nonnemacher, S. L. (2016). Service needs across the lifespan for individuals with autism. Journal of Autism and Developmental Disorders,46(7), 2480–2489. https://doi.org/10.1007/s10803-016-2787-4.

  49. Wong, C., Odom, S. L., Hume, K. A., Cox, A. W., Fettig, A., Kucharczyk, S., et al. (2014). Evidence-based practices for children, youth, and young adults with autism spectrum disorder: A comprehensive review. Journal of Autism and Developmental Disorders,45(7), 1951–1966.

  50. Yang, L. J. (2003). Combination of extinction and protective measures in the treatment of severely self-injurious behavior. Behavioral Interventions,18(2), 109–121. https://doi.org/10.1002/bin.

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Correspondence to Emily Gregori.

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Gregori, E., Wendt, O., Gerow, S. et al. Functional Communication Training for Adults with Autism Spectrum Disorder: A Systematic Review and Quality Appraisal. J Behav Educ 29, 42–63 (2020). https://doi.org/10.1007/s10864-019-09339-4

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Keywords

  • Autism
  • Adults
  • Challenging behavior
  • Functional communication training
  • Differential reinforcement