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DOCUMENT RESUME

ED 359 697 EC 302 257

AUTHOR Durand, V. MarkTITLE Using Functional Communication Training as an

Intervention for the Challenging Behavior of Studentswith Severe Disabilities.

PUB DATE May 93NOTE 21p.; In: Kupper, Lisa, Ed. The National Symposium on

Effective Communication for Children and Youth withSevere Disabilities (2nd, McLean, Virginia, July10-12, 1992): Topic Papers, Reader's Guide &Videotape. p89-108. See EC 302 252.

PUB TYPE Information Analyses (070) Speeches/ConferencePapers (150)

EDRS PRICE MF01/PC01 Plus Postage.DESCRIPTORS Aggression; Behavioral Science Research; *Behavior

Change; *Behavior Modification; Behavior Patterns;*Behavior Problems; *Communication Skills; ElementarySecondary Education; Generalization; *Intervention;Maintenance; Outcomes of Treatment; Self DestructiveBehavior; Self Injurious Behavior; *SevereDisabilities

ABSTRACTThis paper reviews evidence of the success of

behavior intervention approaches which teach students withchallenging behaviors alternative functional communication behaviors.Research supporting the view that challenging behavior is a form ofnonverbal communication is reviewed, noting the importance ofidentifying what such individuals are "saying" with their behaviorproblems. Functional communication training is described as providingthe consequences originally maintaining the target behavior with anew more appropriate behavior. Specific interventions which usedfunctional communication to reduce such behavior problems asaggression, self-injurious behavior, and stereotyped orself-stimulatory behaviors are reviewed. Factors affecting theinitial effectiveness of functional communication training includematching responses to functions of the challenging behavior andensuring that the appropriate behavior is more response efficientthan the inappropriate behavior. Factors affecting generalizabilityand maintenance include response acceptability, recognizability ofthe communicative response, and communicative context.Recommendations for implementation stress home-school collaboration,teamwork, and development of secondary prevention strategies. Otherrecommendations address development of a comprehensive model ofbehavior, development of assessment procedures, improved use ofaugmentative communicatirAl strategies, and primary prevention ofserious behavior problems. (Contains 73 references or suggestedresources.) (DB)

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Reproductions supplied by EDRS are the best that can be madefrom the original document.

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U.S. 01PARTNENT OF EDUCATION°floe of Educalonel Aeloserch and ImprovementEDUCATIONAL RESOURCES INFORIAATtON

CENTER (ERIC)

Ns document Ms Men reproduced asreccved from Me poreOn or OrgemzetsenoligInaling

0 Mfnor changes have been made to Improvereproducton dualdy

Using Functional Communication Training as an Interventionfor the Challenging Behavior of Students with Severe Disabilities

byV. Mark Durancl, Ph.D.

State University of New York at Albany

Points of yew ofopontons stated rn thIS deCtpmint do not rwrcessardy represent official0E141 posdon or pOfvCy

Behaviors such as aggression, self -injury, and tantrums have been looked upon as nonverbalforms of communication. Directly following from this view of challenging behavior, interventionefforts have been designed around teaching students more appropriate ways to communicate their wantsand needs. This paper reviews the growing evidence of the success of this approach to reducingchallenging behavior.1 In addition, specific recommendations are outlined for implementation andfuture directions. Of particular note is the crucial role of home-school collaboration and the potentialof early intervention efforts to prevent severe challenging behavior.

Challenging behavior is often citedas a serious obstacle to the education ofstudents with severe disabilities.Behaviors such as aggression, self-injury,and tantrums can disrupt ongoing effortsto include children and youth with severedisabilities in their home school districtsand communities. Efforts to teach suchimportant skills as communication can besignificantly hampered by the presence ofseriously disruptive behavior (e.g., Carr,Newsom, & Binkoff, 1976).

These challenging behaviors areexhibited by a large proportion of studentshaving severe disabilities. Prevalenceestimates for challenging behaviors rangefrom 10% to 40% for persons with severedisabilities (Schroeder, Schroeder, Smith,& Dalldorf, 1978; Shodell & Reiter, 1968).

Clearly, this is a large problem for thosetrying to help these individuals becomemore independent. Because of theprevalence of these behaviors and theirdetrimental effects on habilitation efforts,considerable research has been conductedto improve our understanding ofchallenging behavior and to facilitateefforts to reduce these behaviors.

This paper will focus on recentwork that has viewed challenging behavioras a form of nonverbal communication.Following a brief review of the evidencefor a communicative hypothesis forchallenging behavior, research oncommunication-based interventions will bepresented. The state of practice andimplementation will then be outlined,

1 This paper was prepared for and presented at the Second National Symposium on EffectiveCommunication for Children and Youth with Severe Disabilities, held July 10-12, 1992 in McLean,Virginia. The Symposium was supported through Grant No. H086B10002, a Cooperative Agreementbetween Interstate Research Associates, Inc., and the Office of Special Education Programs (OSEP)of the U.S. Department of Education. The opinions expressed herein do not necessarily reflect theposition or policy of the U.S. Department of Education, and no official endorsement should beinferred.

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2BEST CCFY

V. Mark Durand

along with recommendations for imple-mentation and future directions.

The Correlation Between CommunicationDifficulties and the Presence of

Challenging Behavior

The idea that challenging behaviormay serve as a form of communication hasa long history (Durand, 1990). Crying bychildren, in particular, has frequently beenviewed as an attempt to communicate.Anyone who has observed a crying childand a frantic parent trying to discoverwhat the child wants is struck by thepower of these interactions. The earliestrecorded observations support this notion.Writers including Plato and the Frenchphilosopher Rousseau observed that cryingmay have communicative properties(Plato, circa 348 BC/1960, p. 174;Rousseau, 1762/1979, p. 77). Familysystems theorists have long relied on theidea that nonverbal behavior hascommunicative properties (e.g., Haley,1963; Minuchin, 1974). Furthermore, overthe last several decades, developmentalpsychologists have systematically studiedthe communicative nature of nonverbalbehavior in young children (Bates,Camaioni, & Volterra, 1975; Bruner, 1973;Wolff, 1969).

This paper appears in L. Kopper (Ed.),The Second National Symposium on Ef f ec -tive Communication for Children and Youthwi',h Severe Disabilities: Topic papers,reader's guide & videotape. McLean, VA:Interstate Research Associates.

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Research on the variables main-taining challenging behavior suggests thatchallenging behavior exhibited by personswith severe disabilities can, like communi-cation, serve multiple social functions(Carr, 1977; Donnellan, Mirenda,Mesaros, & Fassbender, 1984; Durand &Carr, 1987; Evans & Meyer, 1985;Gaylord-Ross, 1980). The idea that thechallenging behavior of persons withsevere disabilities can serve a communi-cative function has intuitive appeal. Thesepersons characteristically have difficultycommunicating their wants and needs.Parents and other caregivers oftendescribe persons with severe and multipledisabilities as being "frustrated," becausethey appear to want to communicate butcannot. Correlational research in thisarea also appears to support this idea.For example, Talkington, Hall, andAltman (1971) observed that aggressionwas more prevalent among persons withsevere communication difficulties.Similarly, persons most likely to beengaging in self-injurious behavior havebeen found to be lacking in verbal facility(Shodell & Reiter, 1968).

This conceptualization is of contem-porary importance, because workers in thisfield are proposing that behaviors such asaggression and self-injury may be similarto nonverbal forms of communication(e.g., Carr & Durand, 1985; Day, Johnson,& Schussler, 1986; Donnellan et al., 1984;Durand, 1982, 1986, 1990; Meyer &Evans, 1986; Neel et al., 1983; Schuler &Goetz, 1981). It has proven useful tocompare challenging behavior to otherforms of nonverbal behavior. Looking atchallenging behavior in this way has been

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Functional Communication Training for Challenging Behavior

helpful in intervention efforts. This workhas found that if we can identify whatthese people are "saying" with theirbehavior problems, then we can teachthem other, more constructive ways tocommunicate the same things as analternative to their challenging behaviors.

Communication-Based Intervention

As was previously mentioned,viewing challenging behavior as a form ofnonverbal communication has implicationsfor intervention (Durand & Berotti, 1991).One ramification of this conceptualizationis its effect on the way we view previoustreatment attempts. Let us suppose, forexample, that a young girl is hitting herselfto escape tasks because they are boring.Punishing her self-injury by spraying waterin her face or reprimanding her fails toprovide her with more interesting activitiesand does not teach her a more appro-priate way to express displeasure. Wecould predict that even if the water sprayor reprimands were sufficiently unpleasantto get her to stop her self-injury, the youngwoman would attempt other ways toescape these tasks. Relying on negativeconsequences to "gain control untilteaching can take place" bypasses thefundamental issue -- why is she hittingherself, and how can we address theseconcerns?

The communication hypothesisbriefly outlined in this paper shouldprovide guidelines for teaching alternativesand for improving the environments inwhich our students live. Specifically, if wecould teach our students another, moreacceptable way to communicate for the

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things they are getting with theirchallenging behavior, then they shoulddisplay fewer behavior problems. Also, bylistening to what they are saying with theirchallenging behavior, we can re-structureour interactions with these students inmore appropriate ways.

Review of Functional CommunicationTraining Literature

One intervention strategy thatspecifically uses communication to reducechallenging behavior has been calledfunctional communication training(Durand, 1990). This strategy includesassessing the variables maintaining thebehavior to be reduced and providing thesame consequences for a differentbehavior. It is assumed that if individualscan gain access to desired consequencesmore effectively with the new response,they will use this new response and willreduce their use of the undesirableresponse. Applying this logic tochallenging behavior, one is able to teachindividuals more acceptable behaviors thatserve the same function as their problembehavior. So, for example, we could teachpeople to ask for attention by saying, "AmI doing good work?" This would allowthem to gain teacher attention in thisappropriate way rather than in an inappro-priate way such as through slapping theirface. What follows is a review of the workin this area to reduce challengingbehavior.

V. Mark Durand

Severe Challenging Behavior

A number of studies have beenconducted which demonstrate the value ofthis procedure in reducing severe behaviorproblems (e.g., Carr & Durand, 1985;Durand & Carr, 1991; Durand & Carr, inpress; Durand & Kishi, 1987; Homer &Budd, 1985; Smith, 1985; Smith &Coleman, 1986). In one example, Durandand Kishi (1987) assessed the function ofthe severe behavior problems of fiveadults with multiple disabilities (dualsensory impairments and severe/profoundretardation) by using a rating scale (theMotivation Assessment Scale, described inDurand & Crimmins, 1988). Through thisscale, the researchers found that thechallenging behaviors of these adults weremaintained by escape from unpleasantsituations, social attention from otheradults, and gaining access to favoritetangibles. These individuals were thentaught to nonverbally communicaterequests that were equivalent to theassessed functions of their behaviorproblems. In other words, they weretaught requests for assistance, requests forattention, and requests for tangibles. Thisintervention resulted in significantreduction in their severe self-injury andaggression.

In a similar study, Smith (1985)intervened with one 18-year-old man withautism who presumably engaged in aggres-sion and self-injurious behavior to obtaintangibles. In particular, an analysisrevealed that aggression and self-injuryoften occurred in the presence of food andwas accompanied by requests for food.Teaching him to request favorite foods

resulted in dramatic reduction in thenumber of his aggressive episodes. It isimportant to note that he was given foodimmediately upon request. Interestingly,as this man's weight began to rise andsubsequently stabilized at a normal weightfor his size, he requested food less.Therefore, even though he could havefood whenever he asked for it, he did notovereat.

Bird, Dores, Moniz, and Robinson(1989) recently documented the succe..zsfuluse of functional communication trainingwith two adult men who had extensivehistories of severe aggression and self-injury. The Motivation Assessment Scalewas used in this study to assess thefunction of these challenging behaviors.Following functional communicationtraining, improvements were observed inappropriate behavior, work productivity,and the use of spontaneous communi-cation. These results were maintained oversix months following intervention. Hunt,Alwell, and Goetz (1988) and Hunt,Atwell, Goetz, and Sailor (1990) observedsimilar improvements in their high school-aged students following conversation skilltraining.

Wacker, Steege, and colleagues(Steege et al., 1990; Wacker et al., 1990)have conducted w series of studies thatfurther support the use of functionalcommunication training as an interventionfor severe challenging behavior. In onestudy (Wacker et al., 1990), they identifiedtwo children who exhibited hand bitingand aggression in the form of slapping andbiting peers and staff. They taught onestudent a communicative response thatmatched the function of his challenging

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behavior and added a response-contingent,time-out contingency. He could sign for abreak from work, but would have to sitalone for a brief time at his table if hewas disruptive. A second student was alsotaught a form of communication thatmatched the function of her challengingbehavior. This was combined withresponse-contingent, graduated guidance.She was taught the signs for a "break"from work, "please," and "eat." Hand-over-hand guidance was used if she didnot comply with requests. The results ofthis approach were that the studentsexhibited little to no challenging behaviorsafter intervention.

In the second study (Steege et al.,1990), two children with severe disabilitieswere taught to press a microswitch thatactivated a prerecorded message of "stop."Because their self-injurious behavior (handand arm biting) was assessed to be main-tained by escape from tasks, they weretaught a means of requesting a brief endto their tasks. Again, this interventionresulted in significant reductions in theirself-injurious behaviors.

Taken together, these studies havebegun to demonstrate the success of usingfunctional communication training as anintervention for even the more severeforms of challenging behavior. Althoughit is recognized that no one singleintervention approach can be successfulfor all individuals, the cumulative evidencesupports a more optimistic view of usingthese positive support strategies for moreserious forms of challenging behavior.

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Non-Injurious Behavior

Behaviors that are highly consistentand repetitive and that have no apparentadaptive function have been variouslylabeled stereotyped or self-stimulatory(BaumeiLter & Forehand, 1973; Berkson,1967). These behaviors take a variety offorms, including repetitive body rocking,hand flapping, mouthing, and bodyposturing. Explanations for the mainte-nance of stereotyped behavior have oftencentered on their ability to provide theperson with reinforcing sensory input (e.g.,Lovaas, Newsom, & Hickman, 1987).However, some individuals appear toengage in stereotyped motor behavior forsocial reasons. Over time, some peoplewho engage in stereotyped behavior suchas rocking or hand flapping appear tolearn to use these behaviors to do thingssuch as escape from work demands. Forthese individuals, then, teaching communi-cative alternatives would include behaviorsthat evoke specific social reactions byothers (as opposed to producing specificsensory feedback).

Following the logic that somestereotyped behaviors may occur for socialreasons, Durand and Carr (1987) assessedthe rocking and hand flapping of fourindividuals. They found that rocking andhand flapping were maintained by escapefrom unpleasant situations. Using thisinformation, Durand and Carr taughtparticipants to say the phrase "Help meduring difficult tasks. If the work was toodifficult, they could ask for help, and theteachers would provide them with assis-tance. This treatment resulted is signif-icant reductions in stereotyped motor

V. Mark Durand

behavior for all four individuals. Thisfinding has recently been replicated in astudy by Wacker et al. (1990).

In summary, relatively few studieshave so far examined the efficacy offunctional communication training as atreatment for stereotyped motorresponses, but given its non-aversive andconstructive nature, the approach warrantsfurther investigation.

Factors AffectingInitial Effectiveness

An important consideration for theinitial success of functional communicationtraining seems to be matching thecommunicative behavior to the function ofthe challenging behavior. In other words,the new trained response should evoke tip-.same consequences as the targetedchallenging behavior. It is not enough justto communicate others should respondto you if you need or want something.The form of communication being taughtshould match the function of thechallenging behavior, and it should bemore effective than the challengingbehavior in getting the student what he orshe wants. These two factors (responsematch and response efficiency) will bediscussed as they relate to the initialreduction of challenging behavior.

Response Match

Our first study of functionalcommunication training directly addressedthe issue of response match (Carr &Durand, 1985). Following a functionalanalysis of the challenging behaviors of

four students, we taught them responsesthat matched the assessed function of theirbehaviors, as well as responses that didnot match the function of their challengingbehavior. If, for example, a student'schallenging behavior occurred to escapedifficult tasks, then a correspondingcommunicative behavior would be to askfor help. Asking for help would result inassistance, which would make the difficulttask easier. A communicative behaviorthat would not match this behavior wouldbe to teach a request for attention. If thestudent asked for attention but did not gethelp on the task, then it would not matchthe intent of the challenging behavior.

In each case, the students'challenging behavior was reduced onlywhen they used the communicativeresponse that matched the function oftheir behavior. The students' behaviorproblems were not reduced when theywere taught responses that did not matchthe function of their challenging behavior.

To further assess this issue, asecond study was conducted. This studyfocused on the unusual speech of a youngboy with autism (Durand & Crimmins,1987). We conducted two separateanalyses of the function of this boy'sunusual speech and found that it tendedto increase when he was faced with diffi-cult tasks. Our interpretation was that hisunusual speech served to allow him toescape from situations that he foundunpleasant -- in this case, difficult tasks.

The intervention phase of this studyinvolved teaching him to say "Help me"when presented with difficult tasks. Inone condition, the phrase "Help me" wasfollowed by assistance from an experi-

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menter. Under this condition, unusualspeech decreased as expected. It wasassumed that the assistance provided tothe student in effect made the task easier.In a second condition, the phrase wasinstead followed by praise from theexperimenter but not with assistance. Theexperimenter would say "That's goodtalking!" when the boy said "Help me," butdid not help him with his work. Underthese conditions, unusual speech increasedwhen compared to the previous conditionand baseline. Therefore, although thestudent was taught the same communica-tive phrase in each condition, his unusualspeech decreased only when the phraseserved the same function. In both studies,reductions in challenging behavior onlyoccurred when alternative behaviors weretaught that matched the function of theproblem behaviors. Alternative explana-tions such as stimulus control or physicalincompatibility could be ruled out.

Response Efficiency

As was mentioned above, the formof communication being taught must notonly match the function of the student'schallenging behavior, it must also be moreeffective in getting the student thereinforcers he or she obtained with theproblem behavior. It should be easier forthe student to get what he or she wants byasking for it in an appropriate way ratherthan by hitting. In an elegant series ofstudies, Homer and his colleagues havebegun to examine this aspect of functionalcommunication training (Homer & Day,1991; Homer, Sprague, O'Brien, &Heathfield, 1990). This group has found

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that three components of efficiency seemto be involved in the success of functionalcommunication training.

The first component of responseefficiency, physical effort, refers to theactual energy being expended for both thechallenging behavior and the communica-tion. If it is physically easier to get whatyou want with the new communicativeresponse, then that behavior will replacethe challenging behavior. The secondcomponent, schedule of reinforcement,refers to how effective each response is inobtaining the reinforcers. If the communi-cative response is successful each time itoccurs, but the challenging behavior isreinforced only occasionally, then thecommunication will replace it. Finally, thedelay in receiving the reinforcers will alsoaffect whether or not functional communi-cation training will be effective. Ifindividuals delay too long in responding tothe communication, it will not successfullycompete with the challenging behavior.

The research on response matchand response efficiency points out that itis not enough just to teach communica-tion. In order for functional communi-cation training to reduce challengingbehavior, the new behaviors being taughtmust match the function of the challengingbehavior and must be more effective inobtaining those things previously obtainedthrough the problem behaviors.

Factors Affecting Generalizationand Maintenance

Research has begun to examine ifand how functional communication train-ing generalizes to new people and settings,

V. Mark Durand

and if and how it maintains over time(Durand ,Sc Carr, 1991, 1992). Severalfactors appear to affect generalization andmaintenance. These factors include theacceptability of the communicativeresponse, the recognizability of thecommunicative response, and the contextin which the student is communicating.

Acceptability

One aspect of response success isits acceptability to significant others. Ifthe new communicative response is seenas unacceptable in community settings,then the desired response will not beachieved. A number of anecdotes haveattested to this aspect of generalizationand maintenance. For example, onegroup relayed their dismay that, althoughfunctional communication training hadbeen successful with one man they wereworking with, it had not been successfulout in the community. When questioned,it was revealed that they taught a 31-year-old man to ask for a hug each time hewanted attention. Although this wasacceptable in their program, it waspointed out that an adult man askingstrangers for a hug would probably not beviewed positively in most communities. Itmade sense that his disruptive behaviordid not decrease in the community (i.e.,the communication he had been taught,the hug, would not generalize to settingsand individuals outside of the program).

To date, there has been littleempirical evidence for this aspect offunctional communication training,although one study addressed this factorindirectly. Durand and Kishi (1987) used

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functional communication training toreduce the severe challenging behaviorexhibited by five individuals withsevere/profound mental retardation anddual sensory impairments (deaf/blind).One participants would scream andremove her clothes, apparently to obtainstaff attention. Our first attempt atintervention involved teaching her to raiseher hand as a means of signaling the staffto attend to her. Despite the fact that shelearned to raise her hand, over time somestaff did not respond to her requestsconsistently. When they were very busydoing chores around the home, they foundthat they could not respond to her eachtime she raised her hand.

We decided to change the meaningof the raised hand. Thus, instead ofmeaning "Come spend some time withme," we now taught the staff that herraised hand was to mean "Can I helpyou?" Each time she raised her hand itmeant they were to take her along on thechores with which they were so busy. Thestaff accepted this form of attention asappropriate (she received their attentionas well as learned new skills) and wouldrespond to these new requests. Theseexperiences suggested that, unless theresponse we teach is acceptable to thosearound the individual in question, it willnot be elicit a consistent response by allpeople (no generalization) and may not beeffective over time (no maintenance).

Recognizability

Several studies have addressed theissue of the recognizability of thecommunicative response. In a study of


maintenance, we found that, after initialsuccess with functional communicationtraining, one young boy resumed engagingin his serious self-injury (Durand & Carr,1991). Examining the situation further, wefound that his new teacher could notunderstand what he was saying when hewas trying to get her assistance. Becauseshe did not provide assistance when heasked for it, he began to hit himself again,which tended to result in fewer demandsbeing placed on him. In this study wefound that, by improving the boy's articu-lation skills, the teacher respondedappropriately, and the boy's challengingbehavior was again reduced (Durand &Carr, 1991).

Recognizability of communicativeattempts is of particular importance forstudents with the most severe disabilities.If a student cannot communicate withothers in a way they can recognize, theywill not respond appropriately, and thestudent will go back to what does workhis or her challenging behavior. In ourresearch with students having severecommunicative disabilities, we have begunto use vocal-output assistive devices as themeans of communication (Durand, inpress; Durand & Berotti, 1991). We havefound that not only can students with themost severe disabilities use these devicesto communicate (Durand, in press), butuntrained individuals in the communitycan also understand the requests beingmade by these students and can respondappropriately (Durand & Berotti, 1991).

For example, we recently workedwith a woman with dual sensory impair-ments who would have a tantrum whenshe was bored. Intervention proceeded by

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teaching Donna to request tasks. Hervocal output device (a Wolf communi-cation board) was programmed to say "I'dlike something to do." Sessions begaii byhaving Donna spend a few moments aloneat a desk. Donna was then physicallyprompted to activate the communicationdevice. Teachers responded to herrequests by guiding her to a table thatdisplayed several activities from whichDonna could choose. Soon after Donnacompleted the task, she was againrequired to spend some time indepen-dently. She quickly learned to use thecommunication device without promptsand in the past several months has veryrarely been observed engaging in anydisruptive behaviors.

The vocal output device has alsobeen used to help Donna become moreindependent when she is out in thecommunity. Donna is currently using thedevice to order drinks at Burger King andto request items she would like to buy atthe grocery store. As mentioned earlier,this is an important advantage when usinga vocal output device. Persons working atBurger King and the grocery store do nothave to be specially trained to understandDonna's requests. By pressing a pad ontilt. device, Donna can "say" the phrase"Sprite, please" without help. In contrast,if she used sign language to make herrequests, it is likely that someone wouldbe needed to help translate.

In addition, devices such asDonna's have at times been programmedto speak in both English and Spanish; thisis useful when a student's parents speakonly Spanish at home and the teacherspeaks only English at school. These

V. Mark Durand

devices have permitted us to teachstudents to make relatively simpleresponses (pressing a pad on the machine)that can result in sophisticated output (fullsentences). Again, because the output canbe recognized by anyone, the success ofcommunication training has been extendedinto the community.

Context

For communication to be success-ful, it has to occur within a context thatwill be responsive and supportive. Ifreasonable requests are being made byour students but the setting does notrespond, then functional communicationtraining will not be successful. Here,however, the problem lies not with thestudent or the particular response beingtaught but, rather, with the school, jobsite, or even the home. As we saw in thesection on acceptability, at times there isa fine line between when the response islegitimately not acceptable (e.g., an adultasking strangers for a hug) and when theenvironment needs to change (e.g., notallowing a student to take a brief breakfrom work on occasion). Durand andKishi (1987) found that the initial successof functional communication training withone man was not maintained when staffrefused to honor his occasional requests.Further research is needed to examine thisaspect of training and to develop guide-lines for adequate support.

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Recommendations forImplementation

Specific techniques for teachingcommunication skills have been discussedpreviously and will be the focus of manyof the other papers in this volume.Despite the wealth of important researchon proper prompting, fading, and otherteaching techniques, the actual teaching ofcommunication skills may be among theeasiest steps in reducing challengingbehavior. When dealing with severechallenging behavior, the targets ofintervention necessarily involve more thanteaching one communicative response andresponding to the behavior itself. Often,whole systems need to be re-designed tosupport these efforts (Durand, 1990;Homer, Dunlap, et al., 1990; Meyer &Evans, 1989). The more challengingaspect of this process is providing theproper supports for instruction and thenecessary curricular and environmentalmodifications that may be essential forreaching the goals. For this type ofintervention to be successful, severalimportant components, such as a relation-ship between home and school/work andadequate training, must be in place.

Critical to the success ofinterventions for challenging behavior ishome-school collaboration. Without acooperative relationship between theschool and home, any improvementsobserved following an intervention arelikely to be short-lived and restricted tocertain people, places, and/or times.Home-school collaboration, as used here,means more than just consultation by ateacher with a parent (Meyer, 1989).

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Rather, it involves the ongoing relation-ship between the family and the school asthey work together as a team.

In our own work in this area, wehave targeted students with severechallenging behavior throughout NewYork State. Our training efforts havebegun by developing a team of individualswho work and live with the student.These teams have included parents, otherfamily members, teachers, school psychol-ogists, speech therapists, and admini-strators. The initial training has beenfocused on the team. In addition toproviding training to the team on how toassess the function of challenging behaviorand design effective interventions, we havespecifically focused on promoting the teamprocess. Teams are encouraged to acceptand adopt input from each member. Noone approach is seen as correct; rather,the process of collaboration is seen as themost important first outcome. The "expertrole" is downplayed, and trainees areencouraged to see the trainers asresources rather than the "givers of truth."

Another factor that is all tooapparent is the lack of trained individualsto provide family and staff with guidanceand training in the types of interventionsdescribed here. Successful interventionfor severe challenges involves compre-hensive assessment and the design ofsystems that can cover teaching new skills,changes in curricula, and developingsupport networks. Few people are suffi-ciently familiar with persons with severedisabilities and the types of assessmentsand interventions needed to adequatelyaddress severe challenging behavior.

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Initiatives are needed to train profes-sionals in these complex skills.

In addition to preparing for anddesigning appropriate support systems, weneed to re-assess how we focus ourattention and resources on challengingbehavior. Typically, a great deal ofattention is placed on the studentsengaging in these behaviors only afterserious harm has occurred, or after"everything has been tried and has failed."One new approach to this problem wouldbe to adopt a secondary preventionstrategy. Secondary prevention involvesefforts to shorten the duration of existingcases through early referral, assessment,and intervention (Caplan, 1964). Perhapsa better way to proceed would be to setup systems that identify problems as theyevolve but before they become serious.Secondary prevention would involve givingcurrently minor challenging behaviors thesame intensive scrutiny now afforded tomore serious problems (Dunlap, Johnson,& Robbins, 1990). The goal would be todetermine how and why these behaviorswere being displayed. Once this wasdetermined, appropriate systems could bedesigned to prevent more serious behaviorproblems later on.

Reeommendations forFuture Directions

The study and treatment ofchallenging behavior has received a greatdeal of attention over the last 30 years.Yet, despite the interest and work in thisarea, there is still a great deal we do notknow about these behaviors and theirtreatment. Because our accomplishments

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V. Mark Durand

continue to emerge, there are manyavenues of research which should provefr uitful. Below are several paths that mayadvance our ability to assist people havingsevere disabilities. (For a more detailedlist of recommendations, readers arereferred to Helmstetter and Durand,1991.)

A Comprehensive Model of Behavior

Our understanding of the factorsthat influence the development and main-tenance of challenging behavior continuesto evolve. In order to fully assistintervention efforts, we need a morecomprehensive model of these behaviors.We have become more sophisticated inour understanding of the more discreteinfluences on behavior (e.g., the role ofpositive and negative reinforcement)(Carr, 1977; Day, Johnson, & Schuss ler,1986; Donnellan, Mirenda, Mesaros, &Fassbender, 1984; Durand & Carr, 1987;Evans & Meyer, 1985; Gaylord-Ross,1980). Yet, we are only just beginning tounderstand how more complex events suchas diet, relationships, medical conditions,mood, and sleep can affect challengingbehavior (Gardner, Cole, Davidson, &Karan, 1986; Gardner, Karan, & Cole,1984). It is expected that, as ourunderstanding of these more complexevents becomes integrated into a model ofchallenging behavior, intervention effortswill improve proportionately.

For example, many people describehow a person's mood can affect his or herbehavior. "He was in a bad mood whenhe came in and was disruptive all day.""That first incident in the morning seemed

to put her in a bad mood throughout theday." However, despite recent advances inour understanding of the nature ofchallenging behavior, a great deal is stillunknown about this relationship betweenchallenging behavior and mood. Theinfluence of mood on challenging behaviorhas yet to be studied experimentally inpersons with severe disabilities. Some ofthe questions to be addressed include:Can a "good mood" be induced, and willthat lower rates of behavior problems?Can we prevent 'bad moods," and willthat, in turn, prevent challengingbehavior? There is a great deal we stilldo not understand about challengingbehavior, and more research is needed tofurther untangle these influences.

Assessment

Along with expanding our know-ledge base pertaining to the influences onchallenging behavior, we must, in parallel,continue to develop our assessmentprocedures. Such assessments should becapable of reliably identifying theinfluences on challenging behavior. Oneissue that will need to be addressedinvolves ethical concerns related to the useof some assessments. Specifically, thereare several problems when using a func-tional analysis for assessing challengingbehavior. Functional analysis involves (a)the manipulation of those events that arethought to influence the behavior ofinterest, and (b) the observation of anychange in that behavior (Baer, Wolf, &Risley, 1968, pp. 93-94). For example, ifwe thought that teacher attention influ-enced a student's classroom behavior, a

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functional analysis would involve thesystematic increase and decrease inteacher attention, and an observation ofthe student's behavior under thesedifferent classroom conditions. There isan obvious problem with an assessmentthat will result in increases in the problembehavior under certain circumstances (e.g.,with decreased attention or when attentionis a consequence). Especially with moresevere cases of challenging behavior, it isdifficult to justify any procedure that willpotentially cause harm to the person orothers.

An additional consideration specificto the use of consequences in a functionalanalysis is the possibility of increasing thefuture probability of the behavior. In otherwords, if attention follows screaming, andscreaming increases, then attention is areinforcer. If we are reinforcingscreaming during the functional analysis(e.g., by repeated use of attention as aconsequence), will this adversely affect thebehavior outside of the functional analy-sis? Are we making the problem worse bydoing this kind of assessment? This is aquestion that has not yet been answeredand is one that should be addressed whenconsidering the use of consequences in afunctional analysis (Durand, 1993).

Augmentative Communication Strategies

One of the major obstacles toteaching communication as a way ofreplacing challenging behavior is the modeof output. Many students with severedisabilities have historically had difficultyacquiring formal communication skills.One alternative to both spoken and signed

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speech is the use of augmentativecommunication systems (Baumgart,Johnson, & Helmstetter, 1990; Reich le,York, & Sigafoos, 1991). These systemsare formal or informal strategies thatassist communication efforts instead of orin addition to spoken speech. Thesestrategies have included using communi-cation boards that require students topoint to pictures (Mirenda, 1985; Rotholz,Berkowitz, & Burberry, 1989), vocaloutput devices (Dattilo & Camarata, 1991;Mirenda & Beukelman, 1987), and avariety of other adaptations (Mathy-Laikko et al., 1989). Vocal output systemshave several advantages over otheraugmentative systems. Most importantly,others may be more likely to respond tovocal output devices over communicationboards. Calculator and Dollaghan (1982),for example, have noted that less thantwo-thirds of the initiations made bystudents with communication boards (i.e.,picture books) are responded to by adults.If individuals do not respond to thecommunication of these students, theapplicability of such an interventionapproach for community settings islimited. Fortunately, a variety of vocaloutput devices is currently commerciallyavailable and may be used to promoteeffective communication among personswith profound or multiple disabilities.

In order to provide students whohave severely limited communication skillswith the ability to request reinforcers, wehave recently incorporated the use ofvocal-output communication devices foruse with functional communication train-ing (Durand & Berotti, 1991). Thesedevices should allow students to provide

V. Mork Durand

minimal input (e.g., touching a pad) thatresults in easily recognizable output (e.g., avoice generated from the device request-ing reinforcers in full sentences). Forexample, for a student with escape-maintained problem behavior, it ispossible to teach her to activate a devicethat will produce the sentence "Would youhelp me with this, please?" Using state-of-the-art technology to provide students witha means of communicating wants/needsshould result in reduced rates of chal-lenging behavior.

Primary Prevention

Until recently, there have beenrelatively few demonstrations of thepotential of early intervention for personswith severe disabilities. Fortunately,several groups have begun to apply inter-vention procedures with young children inan effort to prevent more serious, laterproblems (e.g., Dunlap, Johnson, &Robbins, 1990; Lovaas, 1987). One of thelogical outgrowths of a communicationhypothesis of challenging behavior may bespecific guidelines for efforts to preventthese serious behaviors.

If some forms of challengingbehavior develop primarily from a combi-nation of a person's inability to effectivelycommunicate his or her wants and needsin a more acceptable manner, and/orfrom an unresponsive environment, then itmay be possible to intervene with childrenand their environments before thesebehaviors are exhibited. In other words,in addition to attempting to reducealready existing behaviors and identifyingemerging problems (secondary preven-

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tion), it may be possible through specificearly communication training and environ-mental design to prevent some instancesof serious challenging behavior altogether(primary prevention). Again, viewingsome challenging behavior as a form ofnonverbal communication provides specificpredictions about what types of earlyintervention efforts may be most effectivein preventing problem behavior.

Conclusion

We have reviewed recent work thathas focused on replacing challengingbehavior with communication, using atechnique known as functional communi-cation training. A growing body ofresearch supports this approach totreatment as an effective way to reduceeven the most severe forms of behaviorproblems. In addition, this interventionstrategy complements efforts to includepersons with the most severe disabilitiesinto regular education settings and othercommunity environments. Recommenda-tions were made to promote this type oftreatment for challenging behavior byfocusing on home-school collaboration,leadership training, research on theinfluences on challenging behavior,research on assessment methods, and workon prevention strategies. It is encouragingthat positive strategies are beingdeveloped to affect meaningful outcomesfor persons with severe disabilities andchallenging behavior.


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Resources

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O'Neill, R.E., Horner, R.H., Albin, R.W.,Storey, K., & Sprague, J.R. (1990).Functional analysis of problem behavior:A practical assessment guide. Sycamore,IL: Sycamore Publishing Company.

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Video Train* Tape

Institute for the Study of Developmental Disabilities. (1988).Managing behavior in community settings. Bloomington, IN:Indiana Resource Center for Autism, Indiana University.

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