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: 9093820
• 负责人: WAYNE WILLIAM FISHER
• 金额: $ 43.02万
• 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/9093820
• 关键词: Address; Aggressive behavior; Behavior; Behavior Therapy; 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; behavioral momentum; operation; prevent; 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）：智力残疾儿童经常表现出严重的破坏性行为（例如，攻击性、自我伤害行为），对自己或他人构成重大风险，并代表社区融合的压倒性障碍。这些破坏性的行为往往被视为行为干预来自功能分析（FA），这是用来确定环境的前因和后果的场合，并加强目标的反应。一种与FA有着不可分割联系的治疗方法被称为功能性沟通训练（FCT），它涉及破坏性行为的消除和替代沟通反应的强化，其结果是先前强化的破坏性行为。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，通常可减少90%或更多的问题行为，比其他行为治疗更有效。尽管有这些令人印象深刻的发现，但文献中报道的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，并且在更常规的条件下尚未确定治疗有效性。此外，当试图增加父母和其他照顾者使用FCT的实用性和易用性时，大约1/2的病例的治疗效果明显降低，并导致更多的侵入性程序，1目前的项目旨在通过以下方式解决公平贸易条约的这些局限性：证明简单有效的经验评估对于选择最适当的FCT对策的有效性;和（B）表明通过将FCT反应置于与使用多个时间表控制破坏性行为的那些刺激分开且不同的辨别性刺激的控制下，将（1）促进将治疗效果转移给常规护理人员， （2）防止在FCT反应不产生强化期间破坏性行为的死灰复燃，以及（3）防止需要在FCT治疗包中添加惩罚成分以在常规条件下维持最大治疗功效。