Stimulus Control Refinements of Functional Communication Training in ID

项目摘要 严重的破坏性行为是发育障碍的共病， 随着智力残疾严重程度、沟通障碍和同时发生的自闭症谱系而增加 24，78破坏性行为，如自伤行为和攻击性行为，会对儿童造成伤害 和其他人，并增加了机构化的风险，社会孤立，身体限制，药物过度， 使用、拒绝服务和滥用。79临床医生使用功能分析来确定 强化或激发破坏性行为，并开发有效的，基于功能的治疗。 沟通训练（FCT）是一种经验支持的、基于功能的治疗方法， 行为临床医生教孩子使用功能性沟通反应（FCR）来请求治疗。 破坏性行为的终止，破坏性行为在FCT期间处于终止状态。6，39例如，如果 功能分析结果表明，注意力强化破坏性行为，临床医生将提供 注意当孩子使用FCR（“请和我一起玩”）。也不会注意到破坏性的 行为FCT的一个局限性是复发，即在最初有效后破坏性行为的增加 治疗，通常发生在我们将治疗转移给新的治疗师，护理人员或设置时，或者当改变时， 行为分析师将复发描述为（a） 当治疗 上下文改变（例如，将治疗从诊所转移到家庭），12（B）当FCR不 当更新和复苏同时发生时，产生增强、82和超级复苏， 复发的水平比单独使用，14和（c）恢复时，照顾者错误地 提供加强 在计划外的时间。83我们的研究从这个项目的第一阶段，基于行为 动量理论，表明当FCR信号将和不会产生强化在我们的过程中， 多计划FCT（多FCT）程序：（a）防止消退爆发，（B）促进强化- 时间表细化，和（c）防止或减轻复发时，照顾者没有提供计划 9此外，我们的相关初步研究表明，多重FCT通常： (a)迅速减少破坏性行为，（B）促进跨环境的治疗转移， 唤起更新，以及（c）减少了惩罚成分的必要性。我们将进行一项随机临床试验， 一项比较多重FCT与传统FCT有效性的试验，传统FCT没有强化信号 可用性和不可用性，用于缓解续订、超级恢复和恢复。我们还将测试 多FCT +刺激消退，其中我们以渐进的步骤进行每个上下文变化，是否会进一步 减少治疗复发。这个新项目有可能改变研究人员和临床医生 分析和预防治疗复发，从而显著改善儿童的长期结局， 受这些令人衰弱的行为障碍折磨的家庭。

Project Summary Severe destructive behavior represents a comorbid condition of developmental disability for which risk increases with intellectual disability severity, communication deficits, and co-occurring autism spectrum disorder.24,78 Destructive behavior, such as self-injurious behavior and aggression, causes harm to the child and others and increases the risk for institutionalization, social isolation, physical restraint, medication over- use, service denial, and abuse.79 Clinicians have used functional analyses to identify the variables that reinforce or motivate destructive behavior and to develop effective, function-based treatments.4 Functional communication training (FCT) is an empirically supported, function-based treatment that decreases destructive behavior. The clinician teaches the child to use the functional communication response (FCR) to request the reinforcer for destructive behavior, and destructive behavior is on extinction during FCT.6,39 For example, if functional-analysis results showed that attention reinforced destructive behavior, the clinician would provide attention when the child used the FCR (“Play with me, please.”) and would not provide attention for destructive behavior. One limitation of FCT is that relapse, an increase in destructive behavior after initially effective treatment, often occurs when we transfer treatment to new therapists, caregivers, or settings or when change agents implement it incorrectly.8,39,80,81 Behavior analysts describe relapse as (a) renewal when the treatment context changes (e.g., transfer treatment from clinic to home),12 (b) resurgence when the FCR does not produce reinforcement,82 and superresurgence when renewal and resurgence co-occur and cause higher levels of relapse than that produced by either alone,14 and (c) reinstatement when the caregiver mistakenly provides reinforcement at unplanned times.83 Our research from Period 1 of this project, based on behavioral momentum theory, suggested that signaling when the FCR will and will not produce reinforcement during our multiple-schedule FCT (mult FCT) procedure: (a) prevented extinction bursts, (b) facilitated reinforcement- schedule thinning, and (c) prevented or mitigated relapse when caregivers did not deliver planned reinforcement for the FCR.9 In addition, our related preliminary research showed that mult FCT often: (a) rapidly reduced destructive behavior, (b) facilitated treatment transfer across contexts without evoking renewal, and (c) reduced the need for a punishment component. We will conduct a randomized clinical trial to compare the effectiveness of mult FCT to traditional FCT, which does not signal reinforcement availability and unavailability, for mitigating renewal, superresurgence, and reinstatement. We also will test whether mult FCT + stimulus fading, in which we conduct each context change in gradual steps, will further reduce treatment relapse. This novel project has the potential to change the way researchers and clinicians analyze and prevent treatment relapse, thereby markedly improving the long-term outcomes for children and families afflicted by these debilitating behavior disorders.