Stimulus control refinements of FCT interventions for destructive behavior in ID

针对智力障碍破坏性行为的 FCT 干预措施的刺激控制改进

• 批准号: 8722834
• 负责人: WAYNE WILLIAM FISHER
• 金额: $ 43.45万
• 依托单位: UNIVERSITY OF NEBRASKA MEDICAL CENTER
• 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 2019-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8722834
• 关键词: Address; Aggressive behavior; Behavior; Behavior Therapy; Behavioral; Caregivers; Child; Communication; Community Integration; Development; Disease; Economics; Educational Intervention; Educational process of instructing; Effectiveness; Emotional; Ensure; Epidemiologic Studies; Exposure to; Extinction (Psychology); Health; Intellectual functioning disability; Intervention; Link; Literature; Meta-Analysis; National Institute of Child Health and Human Development; Parents; Pilot Projects; Problem behavior; Procedures; Psychological reinforcement; Public Health; Punishment; Reporting; Research; Research Personnel; Resistance; Risk; Schedule; Self-Injurious Behavior; Signal Transduction; Staging; Stimulus; Techniques; Touch sensation; Training; Treatment Effectiveness; Treatment Efficacy; Work; alternative communication; base; operation; prevent; public health relevance; reinforcer; response; social; theories; therapeutic development; treatment effect

DESCRIPTION (provided by applicant): Children with intellectual disability often display severe destructive behaviors (e.g., aggression, self- injurious behavior) that pose significant risks to self or others and represent overwhelming barriers to community integration. These destructive behaviors are often treated with behavioral interventions derived from a functional analysis (FA), which is used to identify the environmental antecedents and consequences that occasion and reinforce the target response. One treatment that is inexorably linked to FA is called functional communication training (FCT), which involves extinction of destructive behavior and reinforcement of an alternative communication response with the consequence that previously reinforced destructive behavior. Results from epidemiological studies and meta analyses indicate that interventions based on an FA, like FCT, typically reduce problem behavior by 90% or more and are much more effective than other behavioral treatments. Despite these impressive findings, FCT interventions reported in the literature have typically been developed and evaluated by highly trained experts in tightly controlled research settings, and treatment effectiveness has not been established under more routine conditions. In addition, when attempts have been made to increase the practicality and ease of implementation of FCT for use by parents and other caregivers, treatment efficacy was markedly reduced in about 1/2 of cases and led to more intrusive procedures, such as punishment.1 The current project aims to address these limitations of FCT by (a) demonstrating the effectiveness of a simple and efficient empirical assessment for selecting the most appropriate FCT response; and (b) showing that by bringing the FCT response under the control of discriminative stimuli that are separate and distinct from those controlling destructive behavio using multiple schedules will (1) facilitate tranfer of treatment effects to routine caregivers and settings, (2) prevent resurgence of destructive behavior during periods when the FCT response does not produce reinforcement, and (3) prevent the need to add a punishment component to the FCT treatment package in order to sustain maximum treatment efficacy under routine conditions.

描述(由申请人提供)：智障儿童经常表现出严重的破坏性行为(例如，攻击性、自残行为)，对自己或他人构成重大风险，并对社区融合构成压倒性障碍。这些破坏性行为通常由功能分析(FA)衍生的行为干预措施来处理，功能分析用于识别发生并加强目标反应的环境先行因素和后果。一种与FA密切相关的治疗方法被称为功能沟通训练(FCT)，它包括消除破坏性行为和加强替代沟通反应，其结果是先前强化了破坏性行为。流行病学研究和Meta分析的结果表明，基于FA的干预措施，如FCT，通常可以将问题行为减少90%或更多，并且比其他行为治疗有效得多。尽管有这些令人印象深刻的发现，文献中报告的FCT干预措施通常是由训练有素的专家在严格控制的研究环境中开发和评估的，在更常规的条件下还没有建立治疗有效性。此外，当试图增加FCT的实用性和易用性以供父母和其他照顾者使用时，治疗效果在约1/2的情况下显著降低，并导致更具侵入性的程序，如惩罚。1当前项目旨在通过以下方式解决FCT的这些局限性：(A)展示简单和有效的经验性评估的有效性，以选择最适当的FCT反应；以及(B)表明通过将FCT反应置于区别刺激的控制之下，这些刺激是分开的，不同于使用多个时间表控制破坏性行为的刺激，将(1)促进将治疗效果转移到常规照顾者和 (3)防止在常规情况下为了维持最大的治疗效果而在FCT治疗方案中增加惩罚成分的需要。