Behaviour Modification Applications - Chapter 22

1. Briefly describe the four conditions in the multielement design that Iwata
et al. (1990) used in the functional analysis they carried out on Susie’s SIB.
Attention condition: basically gave her attention when she was doing SIB
Demand condition: to see if the SIB was initiated from escape from demands,
the behaviour modifier was forcing her to do a puzzle she felt was difficult
Alone condition: to see if sib was form of self-reinforcement
Control condition: to see if the SIB occurred in the absence of the 3 other
conditions
2. What does the term functional assessment refer to?
Functional assessment refers to three approaches used to identify the causes
(antecedents and consequences) of specific problem behaviours. There are three
types of functional assessments which include functional analysis, interview
and/or questionnaire assessment, and observational assessment.
3. Define functional analysis
o Functional analysis is the systematic manipulation of environmental events
to experimentally test their role as antecedents or consequences in
controlling or maintaining specific problem behaviours.
o In experimental functional assessment – the behaviour modifier directly
assess the effects of possible controlling variables on the problem behaviour.
4. Briefly discuss, with example, what the results of Iwata et al.’s research
suggests for the treatment of severe self-injurious behaviour
Even though the form of SIB may be similar from one person to another, the
function can be different. This implies that treatment of an operant problem
behaviour should be based on the function of the behaviour, not on its form. Ex)
one child’s SIB could be maintained by an adults attention, and another child’s
behaviour could be maintained by trying to escape demands
5. Describe the three limitations of functional analysis
1) The amount of time required to carry out a functional analysis may put a
large strain on available staff.
o For example, in a summary of 152 functional analyses reported that the
length of assessment of individual clients ranged from 8 to 66 sessions, a
lot of time for trained staff to take from their other duties
o A way to reduce this is to use the alone condition as a screening phase
when internal sensory reinforcement is suspected.
2) It cannot be readily applied to dangerous or extremely disruptive
behaviours.
 o An example would be a child screaming before becoming aggressive. In
some cases, if a functional analysis of the precursors is carried out and
the results are used to treat and eliminate the precursors, the more severe
behaviours will be eliminated as well.
3) A third limitation of functional analysis is that some behaviour problems
occur at frequencies of less than one per day or per week.
o Functional analyses of such low-frequency behaviours require a great
deal of time before sufficient data can be obtained to draw valid
conclusions.
o However, it has been found that waiting for the problem behaviour to
occur and initiating a functional analysis at the right moment when it is
occurring can result in a functional analysis that yields meaningful results
6. Briefly describe how each of the three limitations of functional analysis has
been addressed in attempts to overcome these limitations.
1) Only one or two repetitions of some of the conditions and a decrease in
session length to 5 minutes can often give meaningful results.
2) Most extremely dangerous behaviors are often preceded by behaviors that are
not as dangerous so if a functional analysis of these precursors is carried out and
is used to treat and eliminate these precursors, the more severe behavior will be
eliminated as well.
3) Waiting for the problem behavior to occur and initiating a functional analysis
right at the moment when it is occurring can result in a functional analysis that
yields meaningful results

Interview and/or Questionnaire Functional Assessments

o Another way to identify the antecedents and consequences that control
problem behaviour is to interview the client or people who are familiar with
the client.
o If verbal, the client may be able to say why he/she engages in a particular
behaviour. If nonverbal, people familiar with the client may be able to
provide the necessary information.
o While functional assessment questionnaires (client and/or people familiar
with the client are ask a standardized series of relevant questions) haven’t
shown good reliability or validity when compared to functional analysis,
they are not useless.
o Questionnaires such as QABF, MAS, and FAST have three uses:
1) They provide a rapid and consistent way to gather information.
2) The information they provide may serve as a basis for obtaining follow-
up information.
 3) when there is high agreement among several informants on a
questionnaire, it may be possible to save time in conducting a functional
analysis by ruling out some potential reinforcers of the problem behavior.

Observational Functional Assessments

o Another way to attempt to identify the variables maintaining a problem
behaviour is to do an observational or descriptive assessment
o In this assessment one carefully observes and describes the antecedents and
immediate consequences of the problem behaviour in its natural settings.
o From these descriptions, one infers in which antecedent stimuli,
motivational variables, and consequences are controlling the problem
behaviour. Then one devises a treatment plan based on these
inferences.
o Interviews, questionnaires and observational assessment is not as
accurate as functional analysis for identifying the causes of problem
behaviour

Another approach to Functional Assessment: Hypothesis Testing

1. Collect data on the problem behaviour – this includes questionnaires, interviews,
and direct observations
2. Form hypotheses regarding the variables controlling the problem behaviour
3. Experimentally test the hypotheses – Note: This step constitutes a functional
analysis (involving manipulating environmental variables to determine how those
variables are related to the problem behaviour)
4. Implement an intervention plan
5. Evaluate the effects of the intervention

7. For what two causes of problem behaviours of children did Carr and
Durand (1985) first use the hypothesis-testing approach?
Problem behaviour causes by children:
1) When children are receiving low amounts of reinforcement
2) Asked to perform tasks that are difficult for them
o A effective solution to these problems was to teach the children to solicit
attention from adults when reinforcement is infrequent and to request
assistance from adults when asked to complete difficult tasks.
8. Briefly compare Iwata et al.’s (1982/1994) and Dunlap et al.’s (1993, 2018)
approaches to functional assessment.
In term of similarities, both of their functional assessments involved functional
analysis. In term of differences, note that Dunlap students were older and more
 in the normal range of intellectual functioning. This mean that they can be
communicated with more extensively, which is important for giving and
receiving information regarding their problem behaviours. It also means that the
intervention can be more flexible and complex. Also note that Dunlap
hypothesis-testing approach focuses on managing the problem behaviour as
opposed to treating it.

9. For what types of clients can the hypothesis-testing approach be (a) most
applicable? And (b) least applicable?
Most: older and normal range intelligence level
Least: younger or below average intelligence level
10. What are three indicators that a problem behaviour is probably
maintained by the attention that follows it?
1) Whether the attention reliably follows the behaviour
2) Whether the individual looks at or approaches a caregiver just before engaging
in the behaviour
3) Whether the individual smiles just before engaging in the behaviour.
11. What were the results of the functional analysis of the causes of excessive
delusional statements made by Mr. Jones? What was the treatment for the
delusional statements based on the results of the functional analysis?
The results with Mr. Jones showed that far more delusional statements occurred in
the attention condition than in the alone, demand, or control conditions. Therefore
the treatment involved reinforcing Mr. Jones with attention when he said
reasonable things, and when he made a delusional statement he was ignored for
approximately 10 seconds.
12. What is an indicator that a problem behaviour in being maintained by self-
stimulatory reinforcement?
An indicator that the behavior is self-reinforcing is that it continues unabated at a
steady rate although it has no apparent effect on other individuals or the external
environment.
13. Describe how Rincover and Devaney applied extinction to a problem that
appeared to be maintained by self-stimulatory reinforcement?
Rincover and Devaney applied extinction to a face-scratching problem that was
maintained by internal sensory positive reinforcement by eliminating the tactile
sensations produced by the scratching. The young girl's hands were covered each
day with rubber gloves that did not prevent her from scratching, but eliminated
sensory stimulation (and skin damage). There was an immediate decrease in
scratching rate (and it was eliminated in 4 days). Follow up consisted of removing
the gloves for 10 minutes a day, then for longer and longer periods of time until
they were no longer needed.
The behavior continues undiminished over numerous occasions, even though it
appears to have no social consequences. For example, if a child flushes a variety of
items down the toilet and does not receive any attention for doing so, it may be the
sight of the items disappearing or the sound of the toilet flushing that maintains the
behavior.
14. What is an indicator that a problem behavior is being reinforced by non-
social external sensory stimulation? Give an example illustrating this
indicator.
The individual continues the behavior undiminished over numerous occasions even
though it appears to have no social consequences. Example: During the day, a child
would take a piece of her mother's jewelry and flush it down the toilet, then tell her
mother what she had done. First, the appearance of the of the jewelry swirling
around the toilet bowl before disappearing might have functioned as a sensory
reinforcer. Second, the entire sequence of activities might have been a behavioral
chain that was reinforced by the mother's attention after the child emitted the
sequence of steps and then told her mother what she had done.
15. What were two plausible explanations of the behaviour of the child
flushing jewelry down the toilet? How did the treatment procedure take both
possibilities into account?
(a) It may have been maintained because of external sensory positive
reinforcement (i.e. the appearance of the jewelry swirling around the toilet bowl
may have functioned as a sensory reinforcer). It may have been maintained as a
link in a behavioral chain that was reinforced by the mother's attention when the
child told the mother about flushing the jewelry down the toilet.
(b) The treatment procedure accounted for both possibilities in that it established a
new chain that included taking jewelry and placing it in a jar in the kitchen (instead
of flushing it down the toilet), which produced an audible tinkling sound as a
sensory reinforcer, and the new chain was highly reinforced by the mother's
attention.

A respondent conditioning approach to reducing Anger Responses

Joel is a 26-year old man with a mild intellectual disability who had recently been
dismissed from a dishwashing position due to angry outbursts. A questionnaire
assessment with Joel’s mother, and observational assessments with Joel, led to the
identification of three categories of CSs for respondent components of emotions.
Identification of 3 categories of CSs for respondent components of emotions:

The CSs included

1) "Jokes" - humorous anecdotes told to Joel
2) "Criticism" - especially about deficiencies in Joel's conduct or appearance
3) "Heterosexual Talk" - discussions of dating, marriage, etc.

Treatment focused on counterconditioning:

- Joel first taught how to relax using a process called progressive muscle relaxation
- Then, while in state of relaxation, a CS for anger from one of the categories was
presented
- Across several sessions, more and more of the CSs for anger were introduced,
gradually proceeding up each of the hierarchies from situations that caused the
least anger to those that caused the most anger
- Joel was requested, while at home, to listen to a tape recording that induced
muscle relaxation, and to practice relaxation exercises when CSs for anger were
encountered in everyday life

16. What is a strong indicator that a problem behaviour is being maintained

as a way of escape from demands? How was this illustrated with Susie at the
beginning of this chapter?
The individual engages in the behavior only when certain types of requests are
made of him or her. For example, Suzy was self-abusive when staff requested her
to do things, but not when she was left alone. Other appropriate examples are
acceptable.

Guidelines for conducting a functional assessment

1. Define the problem behavior in behavioral terms.
2. Identify antecedent events that consistently precede the problem behavior.
3. Identify consequences that immediately, although possibly intermittently, follow
the problem behavior.
4. As suggested by behavioral diagnostics, consider health/medical/personal
variables that might contribute to the
problem.
5. Based on guidelines 2, 3, and 4, form hypotheses about (a) the consequent
events that maintain the problem behavior,
(b) the antecedent events that elicit it or evoke it, and/or (c) the
health/medical/personal variables that exacerbate it.
6. Take data on the behavior, its antecedents and consequences in its natural
setting, and health/medical/personal
variables to determine which of the hypotheses in guideline 5 are likely to be
correct.
7. If possible, do a functional analysis by directly testing the hypotheses developed
in guideline 5. Be sure to recognize the special ethical concerns of a functional
analysis. Specifically, recognize that in a functional analysis you are not treating
the behavior, you are deliberately trying to produce it and if successful probably
even reinforcing it. Sessions of functional analysis should therefore be as short and
as few as possible. All procedures used in the functional analysis must be cleared
with qualified medical personnel and carried out by or under the direct supervision
of a qualified behavior modifier. If there is any possibility of self-injury, medical
personnel must be on hand to provide immediate medical treatment. Finally, the
client must benefit from the functional analysis by receiving treatment, as
described in Chapter 23.

17. Describe two alternative strategies that adults might follow to deal with a
nonverbal child trying to escape from demands by screaming.
1) Teach the individual some other way of communicating (such as by finger
tapping or hand raising) that the task is aversive. In this way, the behavioral excess
can be replaced by an adaptive response that produces the same or similar function
as that which was produced by the problem behavior
2) Design a treatment program in which the level of difficulty of the requested
behavior starts low and if gradually increased
18. Describe how escape from internal sensations might be a cause of some
cases of binge eating.
Researchers have provided evidence that some cases of binge-eating can be
maintained because it leads to a decrease (at least temporarily) in unpleasant
emotional responses.
19. Describe an example of how escape from external sensory aversive stimuli
could produce undesirable behavior.
For example, a child might repeatedly remove her shoes because they squeeze her
toes too tightly. Any appropriate example is acceptable.
20. In a sentence for each, outline the six major causes of operant problem
behaviors described in this chapter.

The major causes of problem behaviour can be divided into two categories: operant
and respondent. Causes of operant problem behaviour can be further subdivided
into the six categories:
1) Problem behaviours maintained by social positive reinforcement
o Behavioural excesses often are developed and maintained by the attention
they evoke (see Q10 for the 3 indicators that PB is probably maintained)
o Attention can also function as an SD for PB
o If a functional analysis shows that the PB is maintained by attention,
treatment involving extinction of the PB combined with reinforcement for
desirable alternative behaviour would be recommended.
2) Problem behaviours maintained by internal self-stimulatory reinforcement
o Some behaviours are reinforced by internal sensory reinforcement or self-
stimulation they produce internally aka automatic reinforcement and it is
said to be self-reinforcing
o It is also known as automatic reinforcement because it’s assumed the
behaviour itself is automatically reinforcing without producing any
consequence that another person can control or detect.
o Example, scalp massaging can produce enjoyable tingling feelings but for
some individual such behaviour can maintain extreme self-stimulatory
behaviour that can be self-injurious behaviour that can even be self-injurious
o See Q12
3) Problem behaviours maintained by external sensory reinforcement
o Reinforcing sights and sounds of non-social external environment might
maintain some problem behaviour.
o For an indicator that a particular problem behaviour is being maintained by
external sensory reinforcement, note whether the individual continues the
behaviour undiminished over numerous occasions even though it appears to
have no social consequences.
o If a functional assessment indicates that the behaviour is maintained by
external sensory reinforcement, then a component of the treatment program
might involve external reinforcement of a desirable alternative behaviour.
4) Problem behaviours maintained by Escape from Demands
o For example, when asked to answer difficult questions, some children
engage in tantrums that are maintained by the withdrawal of the request.
o A strong indicator that a problem behaviour is in this subcategory is that the
individual engages in the behaviour only when certain types of demands or
requests are made.
o If a functional assessment supports this type of interpretation, it may be
feasible to persist with requests or demands until the tantrums decrease and
compliance occurs.
5) Problem behaviours maintained by Escape from Internal sensations
o For example, when walking through the woods one is frequently bitten by
mosquitoes that cause itching and if scratching the bitten area relieves the
itching, excess scratching might occur when walking through the woods.
o Such cases should be treated by an appropriately trained behaviour modifier/
6) Problem behaviours maintained by Escape from External Sensory Aversive
Stimuli
o For example, squinting in the presence of bright light or covering one’s ears
to escape a loud sound
 o If there is a possibility that escape from an external sensory stimuli is
maintain an undesirable behaviour arranging for escape extinction might be
an effective treatment component.
o Such treatment component has been applied to feeding disorders when a
child frequently spits out food and does not eat sufficient quantities.
21. What are the two main indicators that a problem behavior is elicited by
prior stimuli vs. is maintained by reinforcing consequences? Give an example
illustrating these indicators.
1) The problem behavior consistently occurs in a certain situation or in the
presence of certain other stimuli and that it is never followed by any clearly
identifiable reinforcing consequence
2) The behavior seems to be involuntary. Ex: The person seems unable to inhibit it
22. What is behavioral diagnostics? In what sense is this term broader than
functional assessment?
o Approach to behavioral assessment in which the therapist diagnoses the
problem after examining antecedents, consequences, and medical and
nutritional variables as potential causes of problem behaviors
o Based on the diagnosis, the therapist develops a treatment plan, tests the plan
under controlled conditions, and if the results are successful, puts the
treatment plan in place including necessary training of persons who will
conduct the program