A demonstration of incorporating discriminative stimuli into an AAC device during functional communication training.

Functional communication training (FCT) is an effective intervention for teaching communication responses and reducing challenging behavior. One limitation of FCT is that frequent reinforcement may be impractical or impossible in many situations. Recently, Mitteer et al. published a tutorial in the journal AAC that provided video models on how to implement an empirically supported strategy for thinning reinforcement during FCT, known as FCT with discriminative stimuli, when teaching with an augmentative and alternative communication (AAC) device. However, no study has empirically evaluated the approach described in that tutorial. This paper details a case study using several single-case experimental designs to teach a non-vocal autistic adult who did not use speech to communicate requests only when reinforcement was signaled to be available by the color of the AAC icons. We demonstrated the efficacy of this approach with unique pairs of discriminative stimuli for tangible and edible items, thinning reinforcement for each stimulus class independently. We then rapidly transferred stimulus control to new icons and integrated both classes of stimuli into a single AAC grid. This first demonstration of embedding discriminative stimuli into an AAC device represents a promising advancement for individuals who do not use speech and may not readily respond to delay or denial cues.

A Bayesian time-to-event pharmacokinetic model for phase I dose-escalation trials with multiple schedules.

Phase I dose-escalation trials must be guided by a safety model in order to avoid exposing patients to unacceptably high risk of toxicities. Traditionally, these trials are based on one type of schedule. In more recent practice, however, there is often a need to consider more than one schedule, which means that in addition to the dose itself, the schedule needs to be varied in the trial. Hence, the aim is finding an acceptable dose-schedule combination. However, most established methods for dose-escalation trials are designed to escalate the dose only and ad hoc choices must be made to adapt these to the more complicated setting of finding an acceptable dose-schedule combination. In this article, we introduce a Bayesian time-to-event model which takes explicitly the dose amount and schedule into account through the use of pharmacokinetic principles. The model uses a time-varying exposure measure to account for the risk of a dose-limiting toxicity over time. The dose-schedule decisions are informed by an escalation with overdose control criterion. The model is formulated using interpretable parameters which facilitates the specification of priors. In a simulation study, we compared the proposed method with an existing method. The simulation study demonstrates that the proposed method yields similar or better results compared with an existing method in terms of recommending acceptable dose-schedule combinations, yet reduces the number of patients enrolled in most of scenarios. The R and Stan code to implement the proposed method is publicly available from Github ( https://github.com/gunhanb/TITEPK_code).

Application of a terminal schedule probe method to inform schedule thinning with multiple schedules.

Multiple schedules are effective at decreasing challenging behavior and maintaining alternative behavior at acceptable levels. Currently, no conclusive guidance is available for empirically deriving multiple-schedule components (continuous reinforcement for alternative behavior and extinction for challenging behavior [discriminative stimulus] and extinction for both alternative and challenging behavior [delta stimulus]) during the schedule-thinning process. In the current investigation, we describe a terminal schedule probe method to determine delta stimulus starting points and strategies for subsequent schedule-thinning progressions to reach caregiver-informed terminal schedules. We review schedule-thinning outcomes for a clinical cohort using a consecutive controlled case series approach and report results for two groups: One group included applications of terminal probe thinning (n = 24), and the other involved traditional dense-to-lean thinning (n = 18). Outcomes suggest that the terminal schedule probe method produced effective treatments with less resurgence of challenging behavior and leaner, more feasible, multiple schedules.

Teaching trainees to implement functional communication training with multiple schedules: An evaluation of training effects and durability.

We evaluated the effects of behavioral skills training on improving participant implementation of functional communication training with multiple schedules when working with a confederate. Behavioral skills training produced mastery-level responding for all six participants who required training, providing the first empirically supported training for this functional communication training approach. Next, we assessed durability during training challenges with (a) procedural changes to the original protocol, (b) a novel confederate with different discriminative stimuli and reinforcers, and (c) relapsed confederate destructive behavior. Training effects degraded at least once for all participants and in 62% of training challenges, although continuing to expose the participant to the challenging situations or providing postsession booster training resolved the degradation in most cases. We discuss these findings in relation to their clinical implications and directions for future research.

Multiple Schedules Facilitate Rapid Noncontingent Reinforcement Schedule Thinning.

We evaluated a noncontingent reinforcement treatment that included initial brief exposures to signaled alternation of availability and nonavailability of reinforcement, followed by rapid schedule thinning. Results confirmed findings from previous research (typically with differential reinforcement schedules) that establishing stimulus control across multiple treatment components facilitated schedule thinning. We discuss both the clinical utility of this procedure and the utility of stimulus control for making interventions more practical for clinicians.

A comparison of RIRD within chained and multiple schedules in the treatment of vocal stereotypy.

Slaton and Hanley (2016) compared the effects of multiple and chained schedules on stereotypy and item engagement for 2 individuals who exhibited automatically maintained motor stereotypy. Contingent access to motor stereotypy (i.e., chained schedules) was more effective than time-based access (i.e., multiple schedules) at reducing motor stereotypy, increasing item engagement, and establishing stimulus control for both participants. We systematically replicated Slaton and Hanley with 2 participants by a) targeting vocal stereotypy, b) including response interruption and redirection as a treatment component across conditions, c) conducting sessions in the natural environment with teaching assistants as change agents, and d) conducting an analysis of the effective treatment component(s). Chained schedules were more effective for 1 participant, whereas both treatments were effective for the other participant. The component analysis showed that different components were necessary for effective treatment for each participant.

Procedures for determining and then modifying the extinction component of multiple schedules for destructive behavior.

As a component of reinforcer schedule thinning following functional communication training, multiple schedules of reinforcement produce desirable rates and patterns of communication responses as an alternative response to destructive behavior. However, reinforcement schedule thinning is a gradual process that can take many sessions to obtain therapeutic goals. The desired outcome is that manding occurs only during signaled intervals of reinforcement with a sufficiently lean terminal schedule of reinforcement availability and low rates of destructive behavior. The purposes of this study were to (a) evaluate an assessment for informing the initial duration of extinction for alternative responding, (b) evaluate the utility of competing stimuli during extinction for alternative responding, and (c) assess a method for fading the availability of competing stimuli. With these procedures, all 4 participants experienced terminal schedules of reinforcement with rapid, robust reductions in destructive behavior soon after baseline. We discuss the implications and directions for future research.

On the Efficacy of and Preference for Signaling Extinction in a Multiple Schedule.

Previous basic research has shown that signaling the extinction component of a compound schedule can be aversive and nonpreferred. However, such discriminative stimuli are common when thinning schedules of reinforcement in practice, and they provide several advantages to clinicians. A limitation of previous applied studies on different arrangements of discriminative stimuli is that researchers have used identical stimuli to signal the availability of reinforcement across conditions that do and do not signal extinction, often doubling exposure to the stimulus signaling the availability of reinforcement. The present experiments corrected this limitation by comparing multiple-schedule arrangements that do and do not signal extinction when unique stimuli signal each component across conditions. Results from three participants indicated that both multiple-schedule arrangements were similarly efficacious when teaching the successive discrimination. However, response patterns differed when testing under a concurrent-operants arrangement, suggesting different patterns of preference across various multiple-schedule arrangements.

Effects of Multiple Schedules of Reinforcement on Appropriate Communication and Challenging Behaviors: A Meta-analysis.

In this review, we summarized and meta-analyzed 35 single-case intervention studies that involved the use of multiple schedules of reinforcement with 78 individuals with intellectual and developmental disabilities. Based on Tau-U calculations, multiple schedules of reinforcement produced an overall large effect for appropriate communicative behavior and an overall moderate effect for challenging behavior. To evaluate variability in study outcomes, we conducted moderator analyses across 21 variables using the Kruskal-Wallis one-way ANOVA test. Our findings suggest that the use of response prompts significantly moderated the effects of multiple schedules of reinforcement for appropriate communicative behaviors. We discuss these findings and provide implications for future research and practice.

An Investigation of Functional Communication Training and Schedule Thinning Using a Multiple Schedule on Elopement to Access Stereotypy.

Individuals diagnosed with autism spectrum disorder (ASD) who engage in stereotypy may also emit a prior, temporally contiguous, high-risk response to access stereotypic behaviors. For example, the participant in this study who was diagnosed with ASD engaged in a chained response that included elopement, often in unsafe locations, to access light switch flipping. Previous research indicates that functional communication training (FCT) with delay fading is a viable approach to reduce chained problem behavior. In this study, we extended previous research by (a) evaluating the generalized effect of FCT and schedule thinning using multiple schedule technology for an automatically maintained chained response, and (b) evaluating whether intervention effects maintained in the participant's optimal context. Results for the participant suggested that FCT with schedule thinning mitigated high-risk chained responding across settings and discrimination training using a multiple schedule assessment effectively signaled available and unavailable times for the participant to emit the chained response which matched the participant's natural schedule parameters.

Formative applications of ongoing visual inspection for trial-based functional analysis: A proof of concept.

Trial-based functional analysis (TBFA) possesses many strategic advantages which make it an ideal candidate for adoption in applied settings. Notwithstanding, some aspects of the analysis remain underdeveloped, including structured guidelines for interacting with obtained data reliably in formative and summative ways. The purpose of this study was to adapt existing ongoing visual-inspection (OVI) criteria to match the idiosyncrasies of TBFA and then to assess their practical utility in applied settings. Thus, we first drafted OVI criteria appropriate for trial-based FA (i.e., TB-OVI). Then, we trained 5 caregivers to conduct TBFAs of their children's challenging behavior and to react to their data as they obtained it, using the TB-OVI criteria as their guide. Finally, we validated interpretations of TBFA outcomes based on TB-OVI criteria through effective intervention. Across 5 participants and 7 opportunities, function-based interventions successfully eliminated challenging behavior.

Stimuli, reinforcers, and the persistence of behavior.

This article reviews evidence from basic and translational research with pigeons and humans suggesting that the persistence of operant behavior depends on the contingency between stimuli and reinforcers, and considers some implications for clinical interventions.

Effects of schedule type and terminal-link duration on choice in concurrent chains.

Four pigeons responded in a three-component concurrent chains procedure in which the terminal-link schedules were either both fixed-interval (FI FI), both variable-interval (VI VI), both mixed-interval (MI MI) or variable-interval fixed-interval (VI FI). Across components within sessions, overall terminal-link duration was varied while schedule types were varied across conditions. For the conditions with homogeneous schedules, the strongest preference was obtained with FI FI, intermediate with MI MI, and weakest with VI VI. Preference increased with overall terminal-link duration for all schedules, but the increase was more rapid for VI FI. The hyperbolic value-added model (HVA) and cumulative decision model (CDM) were fitted to the choice data and accounted for 83.9% and 76.1% of the variance, respectively. However, deviations from both models' predictions were systematic. A modification of the CDM, which assumed that reinforcers delivered after variable delays were more effective, improved the fit of the model and substantially reduced the systematic deviations in residuals. Comparable modifications of HVA produced only limited improvement. Results show that preference in concurrent chains with homogeneous terminal links depends on the degree of variability in reinforcer delays, and that the CDM can provide an excellent account of results across different terminal-link schedules.

A multicomponent approach to thinning reinforcer delivery during noncontingent reinforcement schedules.

We evaluated a noncontingent reinforcement procedure that involved initially providing three subjects with signaled, continuous access to the functional reinforcer for aggression and slowly increasing the amount of time subjects were exposed to the signaled unavailability of the reinforcer. Additionally, alternative potential reinforcers were available throughout the sessions. Results showed immediate and substantial reductions in aggression for all three subjects. The clinical utility of this intervention is discussed, and future research directions are recommended.

Functional analysis and treatment of problem behavior related to mands for rearrangement.

This study is a systematic replication of a functional analysis (FA) of the relation between mands and problem behavior. We extended treatment approaches for this problem behavior function, and describe the treatment of problem behavior related to mands for rearrangement demonstrated by a 12-year-old girl with autism spectrum disorder and Smith-Magenis syndrome. The mands consisted of requests for others to change their body positioning or proximity, or rearrange items back to their original position. An FA confirmed the relation between problem behavior and mand compliance, and functional communication training with extinction decreased problem behavior and increased functional communication responses. Problem behavior remained low as gradually longer nonreinforcement periods were introduced using a multiple schedule.

Preference, resistance to change, and the cumulative decision model.

According to behavioral momentum theory (Nevin & Grace, 2000a), preference in concurrent chains and resistance to change in multiple schedules are independent measures of a common construct representing reinforcement history. Here I review the original studies on preference and resistance to change in which reinforcement variables were manipulated parametrically, conducted by Nevin, Grace and colleagues between 1997 and 2002, as well as more recent research. The cumulative decision model proposed by Grace and colleagues for concurrent chains is shown to provide a good account of both preference and resistance to change, and is able to predict the increased sensitivity to reinforcer rate and magnitude observed with constant-duration components. Residuals from fits of the cumulative decision model to preference and resistance to change data were positively correlated, supporting the prediction of behavioral momentum theory. Although some questions remain, the learning process assumed by the cumulative decision model, in which outcomes are compared against a criterion that represents the average outcome value in the current context, may provide a plausible model for the acquisition of differential resistance to change.

An evaluation of a three-component multiple schedule to indicate attention availability.

Students may engage in high rates of social approach responses at inappropriate times throughout the school day. One intervention that has been used to teach students appropriate and inappropriate times to access attention is a multiple schedule of reinforcement. In this study, we evaluated the efficacy of a multiple schedule that indicated when attention was available or not available in a bilingual preschool classroom during small-group instruction. Results showed that the intervention was effective in bringing students' social approaches under stimulus control.

Evaluation of multiple schedules with naturally occurring and therapist-arranged discriminative stimuli following functional communication training.

Many studies have shown that (a) functional communication training (FCT) is effective for reducing problem behavior, and (b) multiple schedules can facilitate reinforcer schedule thinning during FCT. Most studies tha have used multiple schedules with FCT have included therapist-arranged stimuli (e.g., colored cards) as the discriminative stimuli (S(D) s), but recently, researchers have evaluated similar multiple-schedule training procedures with naturally occurring S(D) s (e.g., overt therapist behavior). The purposes of the current study were to compare the effects of arranged and naturally occurring S(D) s directly during (a) acquisition of discriminated functional communication responses (FCRs) and (b) generalization of discriminated FCRs when we introduced the multiple schedules in novel contexts in which the naturally occurring stimuli were either relatively easy or difficult to discriminate. Results showed that (a) 2 of 3 participants acquired discriminated responding of the FCR more rapidly with arranged than with naturally occurring stimuli, (b) 2 of 3 participants showed resurgence of problem behavior , and (c) 2 of 3 participants showed greater generalization of discriminated responding to novel contexts with arranged stimuli than with naturally occurring stimuli. We discuss these results relative to the conditions under which naturally occurring and arranged S(D) s may promote rapid and generalized treatment gains.

A translational evaluation of transitions.

Transitions with nonhuman animals are typically framed as inescapable changes in signaled reinforcement schedules that result in a pause in responding unique to switches from rich to lean schedules. Pausing is considered to be a function of the aversive qualities of the contrasting reinforcement schedules. Transitions are typically framed in applied research as physical changes in location that evoke problem behavior maintained by the escape of an aversive event or resumption of a preferred event. We attempted to extend the basic framing of transitions to behaviors and contexts of social significance and evaluate a novel treatment for the problem of dawdling by 3 boys who had been diagnosed with autism spectrum disorder during rich-to-lean transitions. Dawdling during physical transitions was most readily observed when transitioning to lean contexts in Experiment 1. We then shortened transition duration in Experiment 2 by programming unsignaled and probabilistic rich reinforcement in the upcoming context.

An evaluation of multiple-schedule variations to reduce high-rate requests in the picture exchange communication system.

Using procedures similar to those of Tiger, Hanley, and Heal (2006), we compared two multiple-schedule variations (S+/S- and S+ only) to treat high-rate requests for edible items in the Picture Exchange Communication System (PECS). Two individuals with autism participated, after they showed persistent requests for edible items after PECS training. Stimulus control was achieved only with the multiple schedule that involved presentation of a discriminative stimulus during reinforcement components and its removal during extinction components (S+ only). Discriminated requests were maintained for the 1 participant who experienced schedule thinning.