A theoretical and methodological proposal for the descriptive assessment of therapeutic interactions.

OBJECTIVE: The goal of this study is to show the development of a strategy for a descriptive assessment of the therapeutic interaction. METHOD: In this study, we develop an observational methodology to analyze the dialogues that took place during 92 sessions conducted in a psychological center in Madrid, Spain, in which 19 adults were treated for various psychological problems by 9 behavioral therapists. A system was developed to codify vocal behavior of both the therapists and the clients; the software The Observer XT was used for recording. Therapeutic interactions were analyzed using sequential analysis. RESULTS: There are three main sequences that synthesize the therapist-client interaction: first, an utterance by the client preceded by a therapist's verbalization, specifically a question (discriminative morphology) and followed by an expression of approval (reinforcement morphology); second, verbalizations of failure or discomfort uttered by the client, followed most often by verbalizations of disapproval (punishing morphology) uttered by the therapist; and third, verbalizations uttered by the client that are discriminated by the therapist after an in-depth explanation and followed by different therapist's utterances (expressions of approval, technical information, etc.). CONCLUSIONS: Depending on how the client responds the results in this study present a starting point for the study of the functional sequences that form the basis of therapeutic change.

A comparative effectiveness trial of functional behavioral assessment methods.

Clinicians report primarily using functional behavioral assessment (FBA) methods that do not include functional analyses. However, studies examining the correspondence between functional analyses and other types of FBAs have produced inconsistent results. In addition, although functional analyses are considered the gold standard, their contribution toward successful treatment compared with other FBA methods remains unclear. This comparative effectiveness study, conducted with 57 young children with autism spectrum disorder, evaluated the results of FBAs that did (n = 26) and did not (n = 31) include a functional analysis. Results of FBAs with and without functional analyses showed modest correspondence. All participants who completed functional communication training achieved successful outcomes regardless of the type of FBA conducted.

A systematic review of the correspondence between descriptive assessment and functional analysis.

Clinicians report that they often rely on descriptive assessments when developing behavior-reduction plans despite literature suggesting that functional analysis is the most rigorous assessment method. Further, research comparing the outcomes of descriptive assessments and functional analyses is mixed, with some studies showing low correspondence and others showing high correspondence. Such persistent use of descriptive assessments suggests that they may yield useful information despite inconsistent correspondence with functional analyses. A more fine-grained analysis of the relation between descriptive assessments and functional analyses may elucidate variables affecting their utility. We conducted a review of 48 studies that included descriptive assessments and functional analyses and evaluated several measures of correspondence between each pair of assessments. Results indicated that descriptive assessments had exact correspondence with functional analyses in 50% of comparisons. Results also suggested that descriptive assessments were more likely to accurately identify and predict the absence of a function relative to the presence of a function and that structured descriptive assessments were more likely to accurately predict functions.

Impact of a Training Package to Improve the Effectiveness of Descriptive Assessment Data.

Identifying the maintaining contingencies of problem behavior can lead to effective treatment that reduces the occurrence of problem behavior and increases the potential for the occurrence of alternative behaviors. Many studies use descriptive assessments, but results vary in effectiveness and validity. Comparative research further supports the superior utility of analog functional analyses over descriptive assessments, but clinicians continue to report the consistent use of descriptive assessments in practice. Direct training on the recording of descriptive assessments as well as the process for interpreting the results are limited. The absence of research-based guidance leaves clinicians to interpret the results as they see fit rather than following best practice guidelines for this critical activity. This study examined the potential impact of direct training on several components of descriptive assessment: the recording of narrative antecedent-behavior-consequence data, interpretation of the data, and the selection of a function-based treatment. Implications for training and practice are reviewed.

An Investigation of the Correspondence between Results of Contingency Space Analysis and Intervention Effects for Addressing Interfering Behavior of Middle-School Youth.

The literature provides various tools for identifying successful interventions for interfering behavior of individuals with intellectual or developmental disabilities, yet less literature is available pertaining to students who do not have cognitive impairments. The purpose of the current study was to investigate the correspondence between the results of contingency space analyses (CSA) and interventions for four middle-school boys who engaged in interfering behavior. Researchers directly observed natural interactions between each student, his teacher, and peers during three baseline sessions. The students' teacher then implemented three intervention conditions. Using direct observation data, researchers conducted a CSA of the baseline data and determined the natural contingencies between student behavior and social consequences. The results of the CSAs were then compared to the effects of the intervention conditions. For three students, results of the CSA were consistent with results of the intervention analysis. Results provide preliminary support for the CSA as a tool for identifying hypothesis-based interventions.

Descriptive assessment of conversational skills: Towards benchmarks for young adults with social deficits.

Descriptive assessments are necessary to identify social norms and establish a foundation for experimental analysis. Much of the social skills intervention literature involves goals that have been selected through interviews and direct observation of behavior without a reference to desired outcomes. The purpose of the current study was to extend research on descriptive assessments of conversations by including additional measures and examining conversational behavior across contexts. We conducted a descriptive assessment of social skills exhibited by 16 neurotypical young adults. Participants had 10-min conversations in groups and 1-on-1 with friends and novel individuals. We then assessed variability within and across participants on a wide array of relevant measures. Throughout the conversations, participants shared the conversation time equally, spent most of the conversation time making on-topic comments, and gazed at their conversation partner more frequently while listening than while speaking. These descriptive data extend current research, inform future experimental analyses, and may guide clinical decisions.

Agreement Between Structured Descriptive Assessments and Functional Analyses Conducted Over a Telehealth System.

This study examined whether experimental functional analyses (FAs) conducted by parents at home with coaching via telehealth would produce differentiated results, and compared these results to the functions identified from structured descriptive assessments (SDAs) also conducted by parents at home via telehealth. Four boys between the ages of 4- and 8-years old with intellectual and developmental disabilities and their parents participated. All assessments were conducted in the children's homes with their parents serving as intervention agents and with coaching from remote behavior therapists using videoconferencing technology. Parent-implemented FAs produced differentiated results for all 4 children in the study. Overall, analyzing antecedent-behavior (A-B) and behavior-consequence (B-C) relations from the SDA videos identified only half of the functions identified by the FAs. For children whose SDA results were differentiated, analyzing A-B relations correctly identified 4 of 5 functions. Analyzing B-C relations correctly identified 5 of 6 functions identified by the experimental FA, but overidentified attention for all children. Implications for conducting functional analyses and interpreting structured descriptive assessment via telehealth are discussed.

The rooting reflex as an infant feeding cue.

Experts in infant health and development consider the rooting reflex a cue of a baby's hunger and recommend feeding the infant when this reflex occurs. However, the relation between rooting and infant feeding status has not been well established in the literature. In the current study, seven parents documented the occurrence of their newborns' rooting, crying, and a control reflex (palmar grasp) before, after, and between naturally occurring feedings. For all participants, rooting occurred during a greater percentage of reflex checks prior to feedings, whereas the palmar grasp occurred during a similar percentage of checks across these time periods. These results provide empirical support for the rooting reflex as a feeding cue. However, data for only one dyad suggested a high probability of the rooting reflex occurring without crying during prefeeding checks. Thus, our data do not provide evidence that feeding in response to the rooting reflex would preempt infant crying.

Descriptive assessment of problem behavior during transitions of children with intellectual and developmental disabilities.

Transitions from one activity to another may evoke problem behavior from individuals with intellectual disabilities. One explanation for the occurrence of problem behavior could be the change in relative densities of reinforcement between the two activities. We conducted a descriptive assessment of problem behavior with four children during transitions to and from several different contexts. We observed that, in most cases, the probability of problem behavior was greater during a transition to an activity with a lower density of reinforcement than during a transition to an activity with a higher density of reinforcement. We discuss our findings in terms of problem behavior associated with transitions in activities with different reinforcer densities, as well as the possibility that the problem behavior may be associated with shifts in motivating operations.

A Comparison of Descriptive and Functional Analyses of Inappropriate Mealtime Behavior.

In recent years, rather than being used to assess the potential function of a response, descriptive assessment methods have been applied to evaluate potential consequences or contingencies for problem behavior (Borrero, Woods, Borrero, Masler, & Lesser in Journal of Applied Behavior Analysis, 43, 71-88. doi: 10.1901/jaba.2010.43-71, 2010) or to assist with designing baseline conditions to approximate caregiver behavior (Casey et al. in Behavior Modification, 33, 537-558. doi: 10.1177/0145445509341457, 2009). It has been shown that descriptive assessments of some forms of problem behavior (e.g., self-injury, aggression) are not good indicators of behavioral function and should not be used exclusively when conducting functional behavior assessments (Thompson & Iwata in Journal of Applied Behavior Analysis, 40, 333-338. doi: 10.1901/jaba.2007.56.06/epdf, 2007). However, the extent to which descriptive assessments of inappropriate mealtime behavior can predict behavioral function is not yet clear. We conducted descriptive assessments of inappropriate mealtime behavior and compared the results to functional analyses for ten children with severe food refusal. Results showed that, for 71 % of participants, the descriptive and functional analyses matched. These results suggest that the correspondence between descriptive and functional analyses, at least for inappropriate mealtime behavior, may be higher than that for other forms of problem behavior.

A statewide survey assessing practitioners' use and perceived utility of functional assessment.

The field of applied behavior analysis emphasizes the importance of conducting functional assessment before treatment development for problem behavior. There is, however, little information regarding the extent to which practitioners are using functional assessment in applied settings for individuals with developmental disabilities (DD). The purpose of the current study was to conduct a survey to assess the degree to which various types of functional assessment are implemented in agencies that serve individuals with DD in Massachusetts. Practitioners were asked to indicate their perception about and use of the various categories of functional assessment (e.g., indirect assessment, descriptive assessment, and functional analysis). From the 205 respondents who completed the survey, the most frequently used functional assessment was descriptive assessment. Results indicated that although the majority (67.8%) of practitioners believe functional analysis to be the most informative assessment tool for selecting behavioral treatment, only 34.6% of respondents indicated that they typically use functional analysis to inform the development of a behavior plan.

A survey of functional behavior assessment methods used by behavior analysts in practice.

To gather information about the functional behavior assessment (FBA) methods behavior analysts use in practice, we sent a web-based survey to 12,431 behavior analysts certified by the Behavior Analyst Certification Board. Ultimately, 724 surveys were returned, with the results suggesting that most respondents regularly use FBA methods, especially descriptive assessments. Moreover, the data suggest that the majority of students are being formally taught about the various FBA methods and that educators are emphasizing the range of FBA methods in their teaching. However, less than half of the respondents reported using functional analyses in practice, although many considered descriptive assessments and functional analyses to be the most useful FBA methods. Most respondents reported using informant and descriptive assessments more frequently than functional analyses, and a majority of respondents indicated that they "never" or "almost never" used functional analyses to identify the function of behavior.

Using ABC narrative recording to identify the function of problem behavior: a pilot study.

Many professionals report using ABC narrative recording to identify the function of problem behavior in children with developmental disabilities, but research has not established whether their analyses yield valid results. Thus, the purpose of this study was to examine whether the function identified by expert reviewers using ABC narrative recordings would match the one identified by a functional analysis (FA) and the Questions About Behavioral Function (QABF) scale in four children with developmental disabilities. The functions identified by all twelve experts using the ABC narrative recordings matched at least one of the functions identified by the FA for three of four participants. The experts' analyses also agreed with the informant-based assessment at a statistically significant level for two of three participants with a conclusive QABF. Altogether, the results suggest that ABC narrative recording may be useful to generate hypotheses to identify the function of problem behavior, but that more research is needed before recommending its use as a standalone functional behavior assessment.

Functional assessment of problem behavior: dispelling myths, overcoming implementation obstacles, and developing new lore.

Hundreds of studies have shown the efficacy of treatments for problem behavior based on an understanding of its function. Assertions regarding the legitimacy of different types of functional assessment vary substantially across published articles, and best practices regarding the functional assessment process are sometimes difficult to cull from the empirical literature or from published discussions of the behavioral assessment process. A number of myths regarding the functional assessment process, which appear to be pervasive within different behavior-analytic research and practice communities, will be reviewed in the context of an attempt to develop new lore regarding the functional assessment process. Frequently described obstacles to implementing a critical aspect of the functional assessment process, the functional analysis, will be reviewed in the context of solutions for overcoming them. Finally, the aspects of the functional assessment process that should be exported to others versus those features that should remain the sole technological property of behavior analysts will be discussed.

Evaluation of combined-antecedent variables on functional analysis results and treatment of problem behavior in a school setting.

Call, Wacker, Ringdahl, and Boelter (2005) conducted an analysis in which a single-antecedent condition was compared to a multiple-antecedent condition. The present study extended Call et al. by conducting a structured descriptive assessment (SDA) to identify the antecedent variables most associated with problem behavior in a student with traumatic brain injury and intellectual disabilities. Results indicated that the SDA was effective in identifying relevant antecedent variables that led to the development of an effective intervention in the classroom.

A procedure for identifying precursors to problem behavior.

We describe a procedure for differentiating among potential precursor responses for use in a functional analysis. Conditional probability analysis of descriptive assessment data identified three potential precursors. Results from the indirect assessment corresponded with those obtained from the descriptive assessment. The top-ranked response identified as a precursor according to the indirect assessment had the strongest relation according to the probability analysis. When contingencies were arranged for the precursor in a functional analysis, the same function was identified as for target behavior, supporting the utility of indirect and descriptive methods to identify precursor behavior empirically.