Hanley (2012) discussed a number of obstacles to conducting functional analyses of problem behaviors. Select 3 obstacles most relevant to you and discuss how

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erspectives Functional Assessment of Problem Behavior: Dispelling Myths, Overcoming Implementation Obstacles, and Developing New Lore Gregory P Hanley, Western New England University

ABSTRACT

Hundreds of studies have shown the effcacy of treatments for behavior based on an understanding of its function. Assertions regar legitimacy of different types of functional assessment vary substantially published articles, and best practices regarding the functional assessment cess are sometimes diffcult to cull from the empirical literature or lished discussions of the behavioral assessment process. A number regarding the functional assessment process, which appear to be within different behavior-analytic research and practice communities, reviewed in the context of an attempt to develop new lore regarding tional assessment process. Frequently described obstacles to implementing critical aspect of the functional assessment process, the functional will be reviewed in the context of solutions for overcoming them. aspects of the functional assessment process that should be exported versus those features that should remain the sole technological behavior analysts will be discussed. Keywords: autism, descriptive assessment, functional analysis, functional sessment, indirect assessment, intellectual disabilities, open-ended problem behavior

A

PERSPECTIVES Behavior Analysis in Practice, 5(1), 54-72 54

fter a conversation with Timothy a review of functional analysis proce- dures being published several years later (Hanley, Iwata, & McCord, 2003).

The 277 articles aggregated in that review, along with the hundreds that have been published since 2000, are the primary reasons practitioners are able to conduct effective functional assessments of problem behavior. Much has been learned from the functional assessment research base. Nevertheless, best prac- tices regarding the functional assessment process are sometimes diffcult to cull from this massive empirical literature. I never forgot about the idea of contribut- ing an article that attempted to answer questions that arose when one put down an empirical study and attempted to conduct a functional assessment. This article is an attempt to fll in the gaps that exist between how the functional assess- ment process is described in published

research articles and book chapters and how it probably should be practiced, at least from my perspective.

This perspective piece is not merely a set of opinions however; it is a review of relevant existing literature synthesized with my own practice commitments. Some readers may disagree with particu- lar assertions in this paper and lament that the assertion may not be followed by an empirical reference. I do include references when a satisfactory analysis has been conducted, but I admit that some of my assertions have developed through both experience conducting functional assessments and from my own conceptual interpretation of exist- ing analyses.

There are still many important ques- tions to be asked about the manner in which problem behavior is understood prior to treating it, and I look forward

Vollmer, one of my graduate school professors at the time, in which

we discussed the subtle differences in the manner in which we had learned to conduct functional assessments of severe problem behavior, we concluded that a paper describing functional assessment “lab lore” would be important and well received by those who routinely con- ducted functional assessments. By “lab lore” we were referring to the commit- ments people had to the various strate- gies and tactics involved in the process of fguring out why someone was engaging in severe problem behavior. My graduate school advisor, Brian Iwata, suggested that rather than focus on lore that I fo- cus on detecting the different functional assessment commitments by reviewing the literature base that existed. These collective interactions eventually led to

to reading and hopefully conducting some of that research, but practitioners cannot wait for this next generation of studies to be conducted. They need to know what to do today when given the opportunity to help a family or teacher address the severe problem behavior of a person in their care. I hope that this paper will help practitioners develop their own set of commitments regarding the functional assessment process and perhaps also stimulate some important future research if an assertion occasions skepticism from those who have different commitments.

Some Rationales for Conducting a Functional Assessment

What is a functional assessment of problem behavior? Despite the availability of a variety of functional assessment forms, you can’t hold it in your hand—it is a process that involves a lot of highly discriminated, professional behavior. More precisely, it is a process by which the variables infuenc- ing problem behavior are identifed. Why engage the process? Because it allows you to identify an effective treatment for severe problem behavior.

Behavior modifcation has been effectively used for many years to address problem behavior, especially of those with autism or intellectual disabilities (e.g., Hall et al., 1972; Risley, 1968). So you may be thinking, why conduct a functional assessment of problem behavior? In other words, assigning powerful but arbitrary reinforcers for not engaging in problem behavior or for behavior incompatible with problem behavior and assigning powerful punishers to problem behavior (i.e., modifying behavior) can effectively treat problem behavior, so why bother conducting a functional assessment at all? There are practical reasons; doing so increases treatment precision and effcacy. In other words, doing so identifes treatments that work and that can be practically implemented (as illustrated in Carr & Durand, 1985; Iwata, Pace, Cowdery, & Miltenberger, 1994; Meyer, 1999; Newcomer & Lewis, 2004; Taylor & Miller, 1997). There is an equally important humanistic reason for doing so; conducting a functional assessment dignifes the treatment development process by essentially “asking” the person why he or she is engaging in problem behavior prior to developing a treatment. Behavior modifcation, or program- ming powerful but arbitrary reinforcers and punishers without frst recognizing the unique history of the person being served or the prevailing contingencies he or she is experiencing, is somewhat inconsiderate. It is like saying, “I don’t know why you have been behaving in that extraordinary manner, but it does not matter because I can change your behavior. . .” By contrast, a behavior analytic approach, with functional assess- ment at its core, essentially communicates: “I don’t know why you have been behaving in that extraordinary manner, but I will take some time to fnd out why and incorporate those fac- tors into all attempts to change your behavior.”

To drive this point home, let’s do some perspective tak- ing. Imagine that you experienced some temporary muscle paralysis that does not allow you to talk, write, or engage in controlled motor movements. You are now hospitalized and on several medications that have the common side effect of drying out your eyes, nose, skin, and, especially your mouth. Water is viewable on the rolling table, but unattainable due to your lack of dexterity. You learn that if you bang the bed rails with the back of your hands long enough and loud enough, people will come to you and do things for you, like turning the television on or off or fuffng your pillows, or give you things, one of which is the water that you desperately need. Due to its functionality, the banging continues to such an extent that the backs of your hands are bruised and your care providers an- noyed. The consulting behavior modifer shows up and recom- mends a program of contingent restraint with Posey® mitts “to ensure your safety” and access to music and some Skittles when you are not banging. Your problem behavior occurs much less frequently. It doesn’t go away, but your bruises are healing, and the staff is certainly less annoyed with you. Job well done by the behavior modifer? I doubt you think so.

If there were a process available to allow your care provid- ers to know the simple reason why you were hurting yourself and annoying them, wouldn’t you want it employed? Wouldn’t it have been nice to just be able to push a button that requested assistance obtaining water at any given moment (or perhaps simply have access to a long straw!)? The functional assessment process makes these humane and practical outcomes pos- sible. So let’s return to the earlier question of why conduct a functional assessment and provide a better answer: Behavior analysts should do it to identify effective, precise, personally relevant, and humane treatments for problem behavior (see Hanley, 2010 & 2011, for additional reasons for conducting analyses).

Defning the Parts of the Process

Before I discuss some myths and isolate some good practices regarding the functional assessment process, it is important to defne the three main types of functional assessment. With an indirect assessment, there is no direct observation of behavior; in- direct assessments take the form of rating scales, questionnaires, and interviews (e.g., Durand & Crimmins, 1985; Paclawskyj, Matson, Rush, Smalls, & Vollmer, 2000). With a descriptive assessment, 1 there is direct observation of behavior, but without any manipulation of the environmental conditions (Bijou, Peterson, & Ault, 1968; Lalli, Browder, Mace, & Brown, 1993; Lerman & Iwata, 1993; Mace & Lalli, 1991; Sasso et al., 1992;

1Because there is no manipulation of the environment when a descriptive assessment is conducted, the term descriptive assessment, and not descriptive analysis, is used here because as Baer, Wolf, and Risley (1968) noted, “a non- experimental analysis is a contradiction in terms” (p. 92).

PERSPECTIVES 55

erspectives

Vollmer, Borrero, Wright, Van Camp, & Lalli, 2001). This is the “fy on the wall assessment,” which takes multiple forms like A-B-C recording and narrative recording (Bijou et al.). With a functional analysis, 2 there is direct observation of behavior and manipulation of some environmental event (see Iwata, Dorsey, Slifer, Bauman, & Richman, 1982/1994, for the seminal ex- ample; see Hanley et al., 2003, for an expanded defnition and a review of these procedures). These three types are all functional assessments; the term functional analysis is employed only when some aspect of the environment is systematically altered while problem behavior is being directly observed.

Reconsidering the General Approach to Functional Assessment

The necessity or utility of a least restrictive hierarchical approach to conducting functional assessment has not been proven, although it is apparent in practice and described (Mueller & Nkosi, 2006; O’Neill, Horner, Albin, & Storey, 1997) or implied (Iwata & Dozier, 2008; McComas & Mace, 2000) in book chapters or discussion articles regarding the functional assessment of severe problem behavior. The myth goes something like this: Start the functional assessment process with an indirect assessment. If you are not confdent in the results, conduct a descriptive assessment. If you still have competing hy- potheses regarding the variables controlling behavior, then conduct a standard functional analysis. Like all things based on a least effort hierarchy, this process has intuitive appeal, but there are several reasons why behavior analysts should reconsider their commitment to this assessment hierarchy. The frst is that closed-ended indirect assessments (e.g., Motivation Assessment Scale [MAS], Questions About Behavior Function [QABF]) are notoriously unreliable; when two people who have a history with the person engaging in problem behavior are asked to complete a rating scale, analyses of their responses usually yield different behavioral functions (see Newton & Sturmey, 1991; Nicholson, Konstantinidi, & Furniss, 2006; Shogren & Rojahn, 2003; Zarcone, Rodgers, Iwata, Rourke, & Dorsey, 1991 for some analysis of the reliability of closed-ended indirect assessments; see Hanley, 2010, for a more in-depth discussion of the reliability of these instruments). Without reliability,

2I prefer the term functional analysis to experimental analysis and to experimen- tal functional analysis in both practice and in science in general because of the very diferent efects “function” and “experimental” have on the listener. Function can be understood in a mathematical sense, but more importantly, it also conveys the operant or adaptive nature of the response being analyzed, which has obvious importance in the context of behavioral assessment (see Hanley et al., 2003; and Hineline & Groeling, 2010). Te term experimental does not convey this latter meaning, and instead erroneously conveys that the procedures being implemented are in a sort of trial phase, awaiting a proper analysis of their utility, as in an experimental medication. In addi- tion, considering the quote from Baer et al. included in the footnote above, experimental analysis is redundant.

there is no validity, meaning that there is no opportunity to determine whether the function of behavior is correct from these instruments. Closed-ended indirect assessments are likely preferred because quantifable results can be obtained quickly, and documentation regarding behavior function is created and can be easily fled or shared at an interdisciplinary meeting. Behavior analysts can probably save a little time and be no worse off by simply omitting closed-ended indirect assessments from the functional assessment process.

At the start of the functional assessment process, behavior analysts should indeed talk to the people who have most often interacted with the person engaging in the problem behavior. But, instead of presenting generic scenarios and asking for nu- merical or yes/no answers (i.e., the substance of closed-ended assessments), the behavior analyst should ask questions that allow caregivers and teachers to describe in detail what happens before and after severe problem behavior occurs. These sorts of interviews are known as semistructured and open-ended interviews. The appendix at the end of this article contains an example of this sort of interview that allows behavior analysts to discover common, as well as unique, variables that may evoke or maintain problem behavior. Because of the likely unreliability of interviews, including the one in the appendix, treatments should typically not be designed based solely on the results of these interviews; instead, functional analyses are to be designed from the interview results. An open-ended interview allows for behavior analysts to discover prevalent variables that may be further examined and possibly demonstrated as impor- tant via functional analyses. An important thing to consider is that careful open-ended interviewing used to be the norm prior to conducting functional analyses (see Iwata, Wong, Riordan, Dorsey, & Lau, 1982).3

The second reason the least restrictive assessment hierarchy is troublesome is due to its reliance on descriptive assessment to determine behavioral function. I have yet to come across a study showing that the exclusive results of a descriptive assess- ment were useful for designing a treatment for severe problem behavior. This is likely related to the fact that descriptive assess- ments are notoriously invalid for detecting behavioral function (St. Peter et al., 2005; Thompson & Iwata, 2007). Why might this be? The fact that most people will attend to someone who just kicked them or to someone who makes a jarring sound when they bang their head on a wall leads to most descriptive assessments suggesting that attention is a possible reinforcer for severe problem behavior (McKerchar & Thompson, 2004; Thompson & Iwata, 2001). But studies that have compiled

3Tere are multiple articles that describe conducting an open-ended interview prior to conducting the functional analysis, but the interview appears to only inform the topography of the behavior targeted in the analyses because the analyses in these same studies are all standardized (i.e., including the same test and omnibus control conditions).

PERSPECTIVES 56

data on the prevalence of behavioral function show that atten- tion maintains problem behavior in only about one quarter to one third of the cases examined (Derby et al., 1992; Hanley et al., 2003; Iwata, Pace, Dorsey et al., 1994). The lack of cor- respondence between descriptive assessments and functional analyses is often due to these false-positive outcomes regarding attention (see Thompson & Iwata, 2007).

Consider also that most teachers and parents learn to avoid the presentation of events that evoke negatively reinforced problem behavior (Carr, Taylor, & Robinson, 1991; Gunter et al., 1994); perhaps this leads to the likely false negative out- comes regarding behavior maintained by escape. For instance,

The literature has shown that descriptive assessments are good at teaching us about the prevalence of the environmental events occurring before and after problem behav- ior, but that we need to conduct functional analyses to learn about the relevance of those events for the severe problem behav- ior we are charged with understanding

if the teacher has learned that diffcult math evokes dangerous behavior, the teacher is not likely to present diffcult math to the student while the behavior analyst is conducting the descriptive assessment. Furthermore, it is unclear how auto- matic reinforcement is to be detected and differentiated from socially mediated problem behavior via descriptive assessments (e.g., nonmediated sensory reinforcers cannot be detected and recorded).

The literature has shown that descriptive assessments are good at teaching us about the prevalence of the environmental events occurring before and after problem behavior (McKerchar & Thompson, 2004; Thompson & Iwata, 2001), but that we need to conduct functional analyses to learn about the relevance of those events for the severe problem behavior we are charged with understanding. Therefore, behavior analysts can save a lot of time and be no worse off by simply omitting formal, lengthy, and especially closed-ended descriptive assessments from their functional assessment process. Brief and open-ended observa- tions may be useful for refning operational defnitions of the problem behavior or for detecting possible unique antecedent

or consequent events to examine in a functional analysis, and they may be especially useful if the interview does not yield unique information for designing the analysis.

The third reason the common hierarchy is troublesome is due to its reliance on a standard functional analysis. By stan- dard, I am referring to the rapid alternation of four conditions in a multielement design with tests for all generic contingencies (i.e., an attention test condition, an escape test condition, and an alone condition testing for maintenance via automatic rein- forcement) and an omnibus control condition usually referred to as the play condition (Iwata, et al., 1982/1994). Simply put, there is no standard analysis; a functional analysis of problem

behavior simply involves the direct observation of behavior while some event suspected of being related to problem behavior is manipulated. Note that this widely agreed upon defnition of a func- tional analysis does not specify where the analysis takes place (e.g., in a 3 m by 3 m therapy room or in a busy classroom) or who will conduct the analysis. More important is that it does not specify how many test conditions to include or any particular type of control condition (e.g., the omnibus play condition is not mandatory). These are decisions to be made based on the many factors that will become evident during an open-ended interview.

For instance, if the results of the interview show that one child’s loud moaning and hand fapping occur under most conditions and seem to occur irrespective of the social environment, con- ducting a series of alone sessions frst to see if the problem behavior persists in the absence of social

consequences is a good idea. By contrast, if the results of the interview show that another child’s tantrums most often occur when the teacher removes toys from the child during free play, then two conditions should be conducted, with the access to the toys provided contingent on tantrums in one condition and perhaps uninterrupted access to toys arranged in the second condition. The former condition is known as the test condi- tion because the contingency thought to maintain problem behavior is present, whereas the latter condition is referred to as the control condition because the contingency thought to maintain problem behavior is absent.

The point being made with these examples is that behavior analysts should consider asking simple questions about the variables most likely infuencing problem behavior and test- ing the ones that seem to be most important frst. By testing one hunch at a time, more careful control conditions can be designed in which only the contingency differs between test and control conditions. The interested reader is directed to Thompson and Iwata (2005) for a thorough discussion of the importance of properly designing control conditions. If the

PERSPECTIVES 57

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erspectives hunch from the interview or observation is affrmed in this initial functional analysis, then the behavior analyst will have a stable and sensitive baseline from which to assess the effects of a function-based treatment. Examples of this approach in which results of open-ended interviews informed the design of analyses involving a single test condition and an intimately matched control condition can be found in Hanley, Iwata, and Thompson (2001).

More questions regarding other factors possibly infuenc- ing problem behavior can be asked separately and as often as there are still questions about that which is infuencing prob- lem behavior. In essence, there is no mandate that all questions be asked in a single analysis (e.g., in the analysis format frst reported by Iwata et al., 1982/1994). It is equally important to consider that there is no single analysis that can answer all questions about the environmental determinants of problem behavior. Even comprehensive analyses such as that initially described by Iwata et al. (1982/1994) are incomplete in that these analyses do not test all possible contingencies that may infuence problem behavior. The main strength of a functional- analytic approach is that the analysis is fexible and can be individualized. Although this set of assertions awaits empirical validation, it seems likely that the probability of differentiated analyses will be strongest when more precise and personalized analyses are conducted based on the results of semistructured, open-ended interviewing. I suggest the following for consid- eration as practitioner lore regarding the general functional assessment process: Start with a structured, but open-ended, interview and a brief observation to discover potential factors that may be infuencing problem behavior, and then conduct a precise and individualized functional analysis based on the resultant information to examine the relevance of those discoveries.

Overcoming Common Obstacles to Conducting a Functional Analysis

The importance of the open-ended interview (e.g., Iwata et al., 1982), especially for informing the design of the functional analysis, seems to have been passively overlooked in behavior- analytic practice, whereas the functional analysis (Iwata et al., 1982/1994) appears to be more actively avoided in practice (Desrochers, Hile, & Williams-Mosely, 1997; Ellingson, Miltenberger, & Long, 1999; O’Neill & Johnson, 2000; Weber, Killu, Derby, & Barretto, 2005). Behavior analysts who are charged with treating severe problem behavior but who do not conduct functional analyses are quick to provide multiple reasons why they do not conduct analyses. These reasons may have had merit in the past, but our research base regarding functional analysis has grown tremendously (Hanley et al., 2003; see JABA Special Issue on functional analysis, 2013, volume 46, issue 1). With this growth, solutions for common

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