Stimulus Control Refinements of Functional Communication Training in ID

项目摘要 严重的破坏性行为代表发育障碍的并存状态，其风险 智力残疾严重程度、沟通障碍和共生自闭症谱系增加 24，78破坏性行为，如自残行为和攻击性，会对儿童造成伤害 和其他人，并增加了制度化、社会孤立、身体约束、药物过量的风险- 使用、拒绝服务和滥用。79名临床医生使用功能分析来确定变量 加强或激发破坏性行为，开发有效的、以功能为基础的治疗方法。 沟通训练(FCT)是一种经验性的、以功能为基础的治疗方法，可减少破坏性 行为。临床医生教孩子使用功能性沟通反应(FCR)来请求 破坏性行为的增强剂，破坏性行为在FCT期间处于灭绝状态。例如，如果 功能分析结果显示，注意力强化了破坏性行为，临床医生会提供 当孩子使用FCR(“请和我一起玩”)时请注意。并且不会为破坏性的 行为。FCT的一个局限性是复发，即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到新的治疗师、护理员或环境中，或者当我们改变治疗方式时 代理商不正确地实施它。8，39，80，81行为分析师将复发描述为(A) 治疗时更新 背景变化(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，产生增援，82和超复苏，并导致更高 复发率比单独复发率更高，14和(C)当照顾者错误地恢复时 提供增援 在计划外时间。83我们在本项目第一阶段的研究，基于行为 动量理论表明，FCR何时会和何时不会产生增援信号 多时间表FCT(MULT FCT)程序：(A)防止灭火爆发，(B)促进加固- 日程表精简，以及(C)防止或减轻照顾者未按计划交付时复发 此外，我们的相关初步研究表明，MULT FCT经常： (A)迅速减少破坏性行为；(B)促进跨环境的治疗转移，而无需 (C)减少了对惩罚部分的需要。我们将进行一项随机临床试验 多层FCT与无增援信号的传统FCT的有效性比较 可用性和不可用性，以减少续订、超级复苏和恢复。我们还将测试 我们以循序渐进的方式进行每一种背景变化的多重FCT刺激消退是否会进一步 减少治疗复发。这一新项目有可能改变研究人员和临床医生的方式 分析和预防治疗复发，从而显著改善儿童和 受这些令人衰弱的行为障碍困扰的家庭。

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.