Download Functional assessment and challenging behaviors

Functional assessment and challenging behaviors: Some future directions
Richard P. Hastings and Tony Brown
Department of Psychology
University of Southampton
Correspondence: Richard Hastings PhD, Department of Psychology, University of
Southampton, Highfield, SOUTHAMPTON, SO17 1BJ, UK. E-mail: [email protected]
Running head: FUTURE DIRECTIONS
Abstract
Behavior analysts have had a significant impact on the analysis and intervention of
challenging behaviors in persons with developmental disabilities. In the first part of this
paper, these successes are celebrated. In the remainder of the paper, we present a
selective discussion of three issues that we hope will help to stimulate work with
challenging behaviors still further: (a) the development of challenging behaviors, (b) the
role of rule-governance in challenging behavior, and (c) the behavior of persons
(“mediators”) who directly apply functional assessment and intervention technologies.
Each of these issues is discussed and implications are drawn for future research and
practice in the field. In drawing some conclusions, we focus on the internal and external
validity of functional assessment and interventions.
Functional Assessment and Challenging Behaviors:
Some Future Directions
Challenging behavior is one of the most significant clinical issues in the field of
developmental disabilities. It is a socially defined problem, and encompasses behaviors
that may cause injury to persons with developmental disabilities themselves or to others
(especially their caregivers), and behaviors that might restrict access to typical
community settings (Emerson, 1995). Thus, a wide variety of actions may be described as
challenging, including: self-injurious behaviors, physical and verbal aggression, sexually
inappropriate actions, property-destructive behaviors, disruptive and oppositional
behaviors, stereotyped mannerisms, pica, fecal smearing, screaming, and crying.
As implied by definitions of challenging behavior, such actions have been shown in
research to constitute significant risks to persons with developmental disabilities and to
others. People who engage in challenging behaviors are at risk of abusive behavior from
their caregivers (e.g., Rusch, Hall, & Griffin, 1986; Zirpoli, Snell, & Loyd, 1987), they
are more often placed out-of-home by their families (Sherman, 1988), support staff tend
to avoid them (Hastings & Remington, 1994b), and they may suffer serious injuries.
Challenging behavior may also be associated with increased family stress (e.g., Quine &
Pahl, 1985), and increased stress and burnout in paid support staff (e.g., Jenkins, Rose, &
Lovell, 1997). Furthermore, there is some experimental evidence that persons engaging in
challenging behaviors are evaluated more negatively by members of the public (Jones,
Wint, & Ellis, 1990).
Behavior analysts have been tackling assessment and intervention for challenging
behaviors since the 1960s and 1970s (Remington, 1998). Behavior analysts, both
researchers and practitioners, have established an impressive legacy in their work with
developmental disabilities and challenging behaviors. At the level of theory, the
application of behavioral models of understanding has become increasingly complex.
Many research and conceptual papers have focused on the implications of basic research
in behavior analysis for a broad range of applied problems (see Hastings, 1999 for a brief
discussion). Furthermore, there are examples where basic behavioral phenomena have
been applied explicitly to enhance our understanding of challenging behavior and identify
implications for analysis and intervention (e.g., McGill, 1999).
At the level of assessment, behavior analysts have developed an impressive array of
technologies for the functional analysis of behavior. The classic example here is the
analog assessment technology developed by Iwata and colleagues (Iwata, Dorsey, Slifer,
Bauman, & Richman, 1982/1994). In terms of empirical papers in academic journals,
analog assessment has become a benchmark in functional analysis and has continually
evolved leading to improvements in its sensitivity and utility. For example, Northup et al.
(1991) have successfully used a brief form of the Iwata technology, and the Iwata group
have also published data lending general support to the efficacy of brief experimental
analyses (Kahng & Iwata, 1999). In terms of application, practitioners have developed a
broad range of functional assessment techniques that focus on antecedent factors in
addition to consequences and that can be used in natural settings (e.g., Carr et al., 1999;
Horner, Vaughn, Day, & Ard, 1996; Meyer & Park, 1999).
At the level of intervention, behavior analysts have developed functionally-based
treatments building on a constructional focus espoused by individuals such as
Goldiamond (1974) and Evans and Meyer (1985). This work places an emphasis on skill
development rather than simply the reduction of problem behaviors. A pioneering
example was the development of Functional Communication Training by Carr and
Durand (1985), cited over 320 times since its publication (ISI Social Sciences Citation
Index search in November 2000). “Educative,” “functional,” or “constructional”
approaches to intervention have become the mainstay of academic journals. Behavioral
and developmental disabilities journals are replete with examples of successful and
socially valid (i.e., socially acceptable; Wolf, 1978) interventions for persons who engage
in challenging behaviors.
In applied settings, interventions have also focused on modifying counter-habilitative
environments (e.g., Anderson, Russo, Dunlap, & Albin, 1996; Close & Horner, 1999).
Furthermore, several leading researchers in the field have published accessible training
and intervention-focused books (e.g., Carr et al. 1994; Donnelan, LaVigna, NegriShoultz, & Fassbender, 1988; Durand, 1990; Evans & Meyer, 1985; Meyer & Evans,
1989; O’Neill, Horner, Albin, Storey, & Sprague, 1990; Reichle & Wacker, 1993).
Finally, the results of this research and applied work have led to interventions with
established efficacy (e.g., through meta-analytic reviews; Didden, Duker & Korzilius,
1997; Scotti, Evans, Meyer & Walker, 1991; Sternberg, Taylor & Babkie, 1994).
The behavior analytic field has come a very long way, especially over the past 20
years. Behavioral assessment and intervention strategies offer hope for solving intractable
and potentially very damaging problems for people with challenging behaviors and their
families. Practitioners in Positive Behavior Support (PBS) have also developed a range of
assessment and intervention strategies with a strong empirical pedigree. In the remainder
of this paper, we present a selective discussion of three issues that we hope will help to
stimulate future research in the understanding and intervention of challenging behaviors:
(a) the development of challenging behaviors, (b) the role of rule-governance in
challenging behavior, and (c) the behavior of persons who directly apply functional
interventions. Each of these issues is discussed in turn below. In concluding this
discussion, we focus on external validity and on implications for PBS.
The Development of Challenging Behaviors
Current behavioral models for explaining challenging and other behaviors focus on
maintaining conditions: positive or negative reinforcement processes. Accordingly,
challenging behaviors are likely to occur in future if in similar contexts they have led to
reinforcing consequences in the past (e.g., attention, tangible items such as food, and
avoidance of academic demands). Implicit in these models is the notion that these basic
learning processes are likely to be responsible for the development of challenging
behaviors at least in some cases. However, there is a paucity of theory and research (see
below) explicitly addressing the development of challenging behaviors. In this section,
we will first review existing theory and research addressing the development of
challenging behavior, and then briefly discuss implications for intervention early in the
development of challenging behaviors.
Theory and Research on the Development of Challenging Behaviors
Most of the theory and research on the development of challenging behaviors has
focused on self-injury. This work suggests that self-injury may develop through two basic
routes (Hastings, 1999). First, self-injurious behaviors may evolve from existing
stereotyped responses (Guess & Carr, 1991). Certainly, a large proportion of individuals
with developmental disabilities engage in stereotyped behaviors (e.g., up to 70% of those
living in residential facilities; Rojahn, 1986). These behaviors may arise in the course of
typical human development (Thelen, 1981), but persist in those with developmental
disabilities. However, exactly how stereotypies may evolve into self-injurious actions
remains a topic for debate and investigation.
Guess and Carr (1991) have suggested that repetitive actions can be understood as
developing through three levels. At Level I, repetitive behaviors are viewed as a behavior
state the same way as being asleep, awake, alert and inactive (cf., Guess et al., 1990).
Thus, repetitive actions are regulated internally (i.e., via biological processes of some
kind). At Level II, stereotyped behaviors may regulate arousal levels. For example,
individuals may engage in more stereotypy when little else is going on in their living
environment because it maintains arousal levels, or they might engage in more stereotypy
in unpredictable environments because it reduces feelings of anxiety. At Level III,
repetitive behaviors (particularly those labelled as self-injurious) come to be maintained
by their effects on the social environment. Guess and Carr hypothesize that a large
proportion of repetitive self-injury develops through these three stages (i.e., control by the
physical environment precedes control by the social environment).
The Guess and Carr (1991) model is currently the only explicit behavior analytic
model of the development of challenging behaviors. However, a second more implicit
model (one we might call the collateral effects model) suggests that the establishment of
some self-injurious responses may occur more rapidly than development through a series
of stages. According to this model, certain apparently self-injurious topographies of
behavior may develop originally in one context and under certain contingencies and be
maintained as a result of associated “collateral” effects. For example, Carr and McDowell
(1980) worked with a young boy who began scratching his skin when he had contact
dermatitis. However, when the infection had cleared up, the boy continued to injure
himself. This self-injury had been reliably associated with attention from caregivers
concerned about the infection, and persisted because it continued to be a reliable way of
getting attention from others.
The collateral effects model of the emergence of self-injury, outlined above,
probably leaves little room for behavioral intervention as a prevention measure. In fact,
studies such as Carr and McDowell’s (1980) could be used to support the idea that the
focus of assessment efforts should be on current maintaining factors. We can make sure
that medical problems are identified and treated quickly in people with developmental
disabilities. Other than this, working with a collateral effects model, it is difficult to
predict who will be at risk of developing self-injurious responses: (a) who will develop
medical problems that (b) may lead to topographies of behavior that (c) may be socially
reinforced? The Guess and Carr (1991) model appears to offer more chance of prediction
and thus for intervention early in the course of challenging behaviors.
If challenging behaviors develop through a gradual shaping of responses via mainly
social contingencies, then characteristic continuities in behavior ought to be detectable.
There are at least two important research steps here: (a) to identify early topographies of
behavior that share similarities with challenging behaviors but may be less intense, and
(b) to demonstrate in some way that these actions then come to be related to
environmental contingencies. Murphy, Hall, Oliver, and Kissi-Debra (1999) and Berkson
and Tupa (2000b) identified young children with developmental disabilities who had
begun to engage in behaviors that were similar to self-injurious actions but had not yet
resulted in tissue damage (“proto-injurious” behaviors; Berkson & Tupa, 2000a). The
proto-injurious behaviors identified included: repetitive light tapping of the head on
objects, self-biting not necessarily producing teethmarks, self-scratching that did not
necessarily break the skin, and hair pulling.
Further research by Hall, Oliver, and Murphy (in press) involved an 18-month
longitudinal study of 16 children identified as displaying proto-injurious behaviors. Four
of these children exhibited a significant escalation of their self-injurious actions during
the course of the research; these children were observed to have lower levels of social
contact across the research period than those whose behavior did not escalate. Hall et al.
conclude that children displaying proto-injurious behaviors are at considerable risk for
the development of self-injurious behaviors in the context of low levels of social contact.
Hall et al. did not present data on a control group of children and so a potential increase
in risk for self-injury in children displaying proto-injurious behaviors has not been
established.
Thus, although Guess and Carr’s (1991) developmental model is a long way from
being comprehensively tested, emerging data are consistent with the notion that protochallenging behaviors (less intense topographies of typical challenging behaviors) may
develop into more intense and damaging actions. It is also worth noting that such a
developmental process may occur at any point in a person’s life, although existing
research has focused on children (Berkson & Tupa, 2000b).
To date, there is little theory and research that explicitly addresses the development
of challenging behaviors and more work is required at both of these levels. One starting
point may be to consider the risk factors associated with challenging behaviors in order to
identify potentially significant variables. In a recent meta-analysis of 14 studies that were
designed to compare the characteristics of persons with and without challenging
behaviors, Hodge, Oliver, and Hall (2000) found that the presence of severe/profound
mental retardation, relatively poor language skills, and the presence of a diagnosis of
autism were risk factors for challenging behaviors. As with much meta-analytic research,
Hodge et al. identified significant methodological weaknesses in the research they
reviewed.
The Hodge et al (2000) finding that poor language skills are associated with
challenging behaviors is supported by research studies involving adults with
developmental disabilities (e.g., Bott, Farmer, & Rhode, 1997; Chamberlain, Chung, &
Jenner, 1993; Chung, Jenner, Chamberlain, & Corbett, 1995). At present, there appear to
be no published studies addressing the role of language skills in the emergence of
challenging behavior. However, one recent study has explored the relationship between
language skills and challenging behaviors in young children with developmental
disabilities (Sigafoos, 2000). This research involved a three year longitudinal study of
thirteen pre-school children with developmental disabilities. These children were not
selected on the basis of the presence of proto-challenging behaviors. Using teacher
assessments of challenging behaviors and both receptive and expressive language skills,
Sigafoos found strong negative associations between language skills and challenging
behaviors. These relationships were generally stronger for receptive language skills,
indicating that this variable may be a risk factor worthy of further exploration.
Although a poor language skill is a factor that is open to intervention, the other
identified risk factors for challenging behaviors are unlikely to lead to direct
interventions. At this early stage in research on the development of challenging
behaviors, how can we put developmental thinking into practice?
Development of Challenging Behavior: Implications for Intervention
Thinking developmentally about challenging behaviors has a number of implications
both for assessment and intervention. We have already suggested above that where
behavioral shaping processes are responsible for the development of challenging
behaviors we can actively plan preventative or early behavioral intervention. The
implication of existing theory and research is that in the early stages of the development
of challenging behavior we should be able to detect proto-challenging behaviors. The
presence of proto-challenging behaviors alongside other risk factors may help in the
prediction of which persons will develop serious challenging behaviors. At present, low
levels of social contact in the environment and poor language skills have been identified
as key variables that may be amenable to intervention. Further research is needed in order
to explore other potential risk factors. Existing epidemiological studies have typically
explored associations with variables that are unlikely to have direct implications for
intervention such as physical or sensory disabilities and medical conditions such as
epilepsy (e.g., Cormack, Brown, & Hastings, 2000).
One possibility relating to intervention is that educative strategies such as Functional
Communication Training (FCT; e.g., Carr & Durand, 1985) could be implemented as a
preventative measure for proto-challenging behaviors. Recent research has suggested that
FCT can be used as a means of preventing minor behavior problems from escalating to
more serious ones (Reeve & Carr, 2000). Furthermore, Dunlap, Foster Johnson, and
Robbins (1990) suggested that intensive skill-based intervention might prevent the
emergence of challenging behaviors. Dunlap et al’s rationale is that if people with
developmental disabilities have been taught the basic skills with which to communicate
with others, they will have less need of challenging behaviors when they can achieve the
same ends in a more socially-acceptable manner. This rationale is supported by existing
research suggesting that lack of social contact and poor language skills may be risk
factors for the development of challenging behaviors (see above).
However, an implicit assumption of the position of Dunlap et al. (1990) is that
people with developmental disabilities will grow up and live in environments where
socially appropriate behavior is a more efficient means of “communication” than
challenging behavior. Unfortunately, research data suggest that this is unlikely to be the
case as caregivers are more likely to respond to inappropriate than appropriate behaviors
when inappropriate behaviors are present (see Hastings & Remington, 1994b, for a
review). There is no culture of blame here; there are several reasons why caregivers
might behave in this way and it is crucial that we ask this “why” question (see discussion
of mediator behavior below). However, active programming using active approaches
such as FCT and other communication interventions may be the best means of achieving
effective early intervention for challenging behaviors (cf. Reeve & Carr, 2000). Future
research is needed to explore whether such an approach could be used as a large-scale
prevention program.
Talk of prevention and early intervention for challenging behaviors may also assist in
the adoption of functional assessment and intervention technologies. The existing
technologies are likely to be applicable to both the assessment and intervention of protochallenging behaviors. Therefore, what is required is mostly a new way of thinking about
assessment and intervention for challenging behaviors. We seem to have the right tools,
and our theories seem just as relevant to developmental issues as to issues of maintaining
factors. In this case, behavior analysts have a duty to explore methods for addressing
challenging behavior early, thus saving persons with developmental disabilities and their
caregivers a great deal of physical and psychological pain.
The Role of Rule-Governance in Challenging Behavior
Current functional analysis methods identify the conditions under which challenging
behaviors have reinforcing consequences. At its core, functional analysis focuses on
clarifying behavior-consequence contingencies: the most basic unit of behavior analysis
(Sidman, 1986). The implicit assumption, that all challenging behaviors can be
understood in this simple manner, may be ripe for elaboration. The pertinent issue that we
wish to raise here is that human behavior is very often rule-governed rather than
contingency-shaped (e.g., Catania, Shimoff, & Matthews, 1989).
Rule-Governed Behavior
Research in which human participants were placed on classic reinforcement
schedules found that humans rarely performed in the predictable manner expected of other
infra-human animals (e.g., Holland, 1958; Lowe, 1979; Weiner, 1969, 1970). According
to Lowe (1979, 1983), language is the factor that separates human from infra-human
responses to such contingencies. When given no instructions about how to respond on a
reinforcement schedule task, people engage in a verbal process of problem-solving by
constructing, and minimally testing, their own rules about the contingency programmed
by the schedule. These rules then form the basis of the person’s response to the task.
Rather than being solely shaped by the scheduled contingencies, human behavior is
substantially rule-governed.
Although there may be conceptual and methodological issues that still require the
attention of basic researchers (Madden, Chase, & Joyce, 1998), a growing body of
experimental literature suggests that human participants behave in accordance with
experimenter-provided instructions (e.g., Baron & Galizio, 1983; Catania et al., 1989)
within operant studies. Furthermore, where experimenters do not explicitly provide
instructions, participants report behaving in accordance with self-generated rules (e.g.,
Ninness, Ozenne, McCuller, Rumph, & Ninness, 2000). In each case, participants’
behavior appears to be relatively unaffected by the experimental contingencies in
operation. These effects are examples of the phenomenon of insensitivity; humans use
rules to guide their behavior and this partially insulates their behavior from the effects of
contingencies (Baron & Galizio, Catania et al.). The “insensitive” nature of rule-governed
behavior can be problematic. There are at least two general circumstances where this is
the case. First, the rules governing behavior may not be accurate descriptions of the
contingencies in operation. Second, rule-governed behavior may be unresponsive to
changes in the environment.
In addition to potential problems in insulating behavior from environmental
contingencies, a second property of rule-governed behavior that is important to note here
is that it is in contact with two sets of contingencies: the contingencies for the behavior
itself, and those for the behavior of rule-following (Zettle & Hayes, 1982). Rule following
is a general class of behavior that is reinforced from our earliest days as young children,
and there is no reason to believe that people with developmental disabilities experience
vastly different reinforcement histories in this respect. In fact, the research literature is
replete with examples of interventions to improve compliance in persons with
developmental disabilities (see Smith & Lerman, 1999, for a recent study), a class of
behavior that appears similar to that of rule following.
What has this got to do with the challenging behaviors of people with developmental
disabilities? The crux of the matter is the notion that language is the mediator of rulegovernance of behavior. Research with typical children as young as 18 months has shown
that they too fail to respond like infra-humans to schedules of reinforcement (Bentall &
Lowe, 1987; Bentall, Lowe, & Beasty, 1985; Lowe, Beasty, & Bentall, 1983). This
research showed that children as young as five years old perform on simple reinforcement
schedules in a similar manner to adults. Between approximately two and four years of
age, their patterns of responding are intermediate between infra-human performance and
human adult performance.
The implication is that rule-governance of behavior may emerge alongside the
language abilities of a typical 18-24 month old child. That is not to say that all behavior is
rule-governed at this stage. However, to fully understand behavior we need to consider
the role of language even when these skills are fairly rudimentary. Thus, it appears that
the challenging behaviors of people with developmental disabilities may be under more
complex control than functional assessment technologies typically assume.
It is possible that when functional assessments, and the interventions based upon
them, fail it is because challenging behaviors are in fact partly rule-governed and hence
less “sensitive” to environmental contingencies (see above). If both contingency shaping
and rule-governance processes maintain challenging behaviors, functional assessment
would need to address both of these possibilities in order to have maximum explanatory
power. This has a number of implications both for assessment and intervention with
challenging behaviors.
Implications of Rule Governance
The first significant implication of considering that challenging behaviors may be
both contingency-shaped and rule-governed is that different assessment and intervention
methods may be needed. Research is needed to establish relations between the language
skills and history of reinforcement for rule following of people with developmental
disabilities and the success or failure of both functional assessment and intervention
strategies. In this way, we may be able to develop a series of criteria that help select
assessment and intervention on the basis of the language skills and general compliance
with rules of persons with challenging behaviors. These possibilities could be explored in
future research.
There may be assessment and therapeutic models already in existence that rely on
language skills within the typical range of development that could be applied to persons
with developmental disabilities. For example, several groups have used cognitive
behavior therapy with individuals with developmental disabilities for classic mental
health problems such as depression but also for challenging behaviors such as sexually in
appropriate actions (e.g., Kroese, 1998; Lindsay, Neilson, Morrison, & Smith, 1998).
Others have established test batteries to assess the suitability of persons with
developmental disabilities for cognitive behavior therapy in terms of their existing or
potential language skills such as the ability to label emotional experience (Dagnan &
Chadwick, 1997). Research could usefully establish which techniques under what
circumstances and in combination with which existing functional technologies may be
appropriate for use with individuals who engage in challenging behaviors.
Perhaps the most intriguing and challenging problem is how to assess and intervene
with individuals who have not developed sufficient skills to benefit from traditional
language-intensive approaches. Although there are no direct data as yet to support this
position, we might conclude that existing assessment and intervention strategies could be
expanded in order to include the possibility of rule-governed challenging behaviors. In
particular, theoretical and basic research is needed in order to conceptualize a range of
more complex functional relations for challenging behaviors. These “new” functional
relations could then be addressed in assessment tools.
Our discussion so far implies, and this remains to be tested, that challenging
behaviors of people with even relatively poor language skills are fairly likely to be at
least partially rule-governed. However, it is evident that existing interventions have some
success with individuals with relatively advanced language skills. There are at least two
ways of explaining such successes. The first explanation may be that some challenging
behaviors are sensitive to environmental contingencies and are not rule-governed. We
also suggested above that challenging behaviors may be both contingency-shaped and
rule-governed. Thus, existing technologies are likely to have some success.
The second possibility is even more tentative and suggests that challenging behaviors
may well be rule-governed but still amenable to contingency-based intervention. It may
be the case that powerful or highly valued reinforcers can mitigate against the insulating
effects of rules (cf. Hastings, Remington, & Hall, 1995). Experimental laboratory
research on rule-governance has typically used fairly trivial consequences, and this may
explain why the insulation effect is observed. Clinical contexts may provide a stronger
test of the insulating effects of rules. Thus, functional assessment and intervention
approaches may have efficacy with individuals with relatively advanced language skills
when the reinforcers used in intervention are powerful enough to over-ride the
contingencies associated with rule following.
In the preceding section, several of the points discussed have been speculative. This
illustrates the paucity of both theoretical and empirical work addressing the issue that
challenging behaviors may, at least under some circumstances, best be viewed as rulegoverned. Our contention is that there is no reason to suppose that challenging behaviors,
which are a socially defined problem, will be a special case of human behavior where
language has no effect. Clearly, at present, there is no direct evidence of the role of verbal
rules in the development or maintenance of challenging behaviors. However, we are
suggesting that the question needs to be asked. Given potential implications for
assessment and intervention, we need to rule out rules or rule them in. Thus, there is a
need for research addressing the possible rule-governed nature of challenging behaviors.
If readers remain unconvinced, consider whether it is plausible that the behavior of
mediators is partly rule-governed (see following section) and if so why the same
behavioral processes would not play a role in the behavior of people with developmental
disabilities.
The Behavior of Persons who Directly Apply Functional Technologies
Since the early days of the use of behavioral interventions for applied problems,
behavior analysts have recognized the key role of mediators: parents, teachers, and other
support staff who are responsible for implementing behavioral interventions (e.g., Tharp
& Wetzel, 1969). Research studies (e.g., McGimsey, Greene, & Lutzker, 1995; Neef,
1995; Parsons & Reid, 1995; Shore, Iwata, Vollmer, Lerman, & Zarcone, 1995) show
that it is possible to improve the level of behavioral skill of mediators and as a result the
behavior of the focus person may change for the better. The implicit assumption is that
the behavior of mediators is related to the level of their behavioral knowledge and skill. If
persons with developmental disabilities have problems, we may be able to solve these at
least partly by training the mediators. However, it is likely that processes other than
knowledge and skill learning determine mediator behavior, and these processes need to
be more fully understood.
Challenging Behavior: The Significance of Mediators’ Behavior
In the case of challenging behavior, it is crucial that we have a good understanding of
the processes underlying mediator behavior. This is for three very important reasons.
First, although many published functional assessments appear to be conducted by
specialist clinical teams (Carr et al. 1999) mediators are relied upon to provide
information for or to conduct functional assessments in the majority of typical service
settings (Desrochers, Hile, & Williams-Moseley, 1997). Second, mediators are
increasingly called upon to participate in interventions especially in the context of
Positive Behavior Support. Finally, theoretical models of challenging behaviors
demonstrate that the behavior of mediators and the behavior of persons with
developmental disabilities are inseparable.
This second point is derived from two sources of evidence. The first is that published
data suggest that a large proportion of challenging behaviors serve socially-related
functions (Applegate, Matson, & Cherry, 1999; Derby et al. 1992; Iwata et al. 1994).
Challenging behaviors typically are maintained by access to attention or tangibles
mediated by others, or are maintained by escape or avoidance of social interactions or
certain activities. Thus, in what appears to be the majority of situations, the antecedents
and consequences of challenging behaviors are the behaviors of other people. To fully
understand challenging behavior itself, we need to analyze these mediator behaviors
(Hastings, 1997, 1999).
The second source of support for a close relation between mediator behavior and
challenging behaviors of persons with developmental disabilities are systems models of
such behavior. Carr and colleagues have shown that challenging behaviors are not only
affected by the behavior of mediators but that challenging behaviors also have effects on
mediator behavior (e.g., Carr, Taylor & Robinson, 1991; Taylor & Carr, 1992). Oliver
has suggested that mediators find challenging behaviors aversive and that their own
behavior serves to avoid or escape these aversive experiences (e.g., Hall & Oliver, 1992;
Oliver, 1995). Thus, mediator behavior maintains challenging behavior in the long term
(cf. Patterson, 1982).
The implication here is that analyses of mediator behavior, as well as child or adult
challenging behavior, may well provide useful information about behavioral functions.
All functional assessments provide data about socially-mediated challenging behaviors,
but a small number of studies have directly explored the possibility that information
about function may be derived from observing mediators’ behavior only. Basically,
watching how others respond to challenging behaviors may tell us something about why
it is occurring. For example, Taylor and Romancyzk (1994) found that observing the
attending behavior of teachers in education settings gave reliable information about the
functions of children’s challenging behaviors.
Despite the importance of mediator behavior to an understanding of challenging
behavior, very little research has focused on mediators of intervention for people with
developmental disabilities (Allen, 1999). By a focus on mediators, we mean an explicit
analysis of mediator behavior. Several studies have addressed the training of mediators
(see above). Furthermore, functional interventions clearly rely on mediators changing
their behavior in order to reduce reinforcement of challenging behaviors and reinforce
appropriate behaviors (cf. Carr & Durand, 1985). Finally, studies have begun to assess
whether analysis of caregiver behavior can contribute to a functional analysis of
challenging behaviors (Taylor & Romanczyk, 1994). In the remainder of this section, we
will briefly review one framework for the analysis of mediator behavior and also discuss
methodological and other conceptual issues relating to future research in this area.
Analysis of Mediator Behavior
Hastings and Remington (1994a) argued that mediator behavior should be addressed
at two levels: the level of the individual mediator, and the level of the service or home
environment. Working from the literature on rule-governed behavior introduced above,
Hastings and Remington (1994a) proposed that mediator behavior may be viewed as both
contingency-shaped and rule-governed. From the contingency-shaping perspective,
mediator behavior may be shaped by the aversive contingencies associated with
challenging behaviors (cf. Oliver, 1995). Individual care providers may also emit selfrules (Zettle, 1990) that guide their response to challenging behavior. At the level of the
service/home environment or culture, other rules and contingencies may affect mediator
behavior. For example, mediators may be instructed to respond to challenging behavior in
accordance with the rules of a behavioral program. Furthermore, managers and others in
services are in a position to implement reinforcing and punishing contingencies for
mediator behavior.
Research on factors determining mediator behavior has addressed both contingencies
and rules at the individual mediator level. Given that mediator behavior may be shaped
by contingencies associated with challenging behavior, research has used self-report
methods to derive support for the fact that mediators find challenging behaviors aversive.
This research shows that mediators report challenging behavior to be disturbing and
associated with negative emotions such as fear, anxiety, sadness, depression, and anger
(e.g., Bromley & Emerson, 1995; Mitchell & Hastings, 1998). Existing research has also
addressed self-rules in terms of the statements that mediators make about the nature,
causes of, and appropriate intervention for challenging behaviors (see Hastings, 1997, for
a review).
A great deal more research is needed in this area to establish the factors responsible
for mediator responses to challenging behaviors. In the end, we will need to return to
systematic experimental manipulation in order to explore whether contingency or rulebased processes are primarily responsible for mediator behavior or whether both
processes play a role (cf. Hastings et al. 1995). Whatever the results of such research,
there will be significant implications for functional assessment and intervention strategies
(see Hastings, 1997, 1999; Hastings & Remington, 1994a, for discussion of some
practical implications).
Although some research has focused on factors at the individual mediator level that
may affect responses to challenging behaviors, there remains very little research
addressing the level of the service environment or culture highlighted in Hastings and
Remington’s (1994a) framework. A small number of studies have focused on staff reports
of factors either impeding or facilitating the use of functional technologies (e.g., Ayres,
Meyer, Erevelles, & Park-Lee, 1994), and various authors have identified key contextual
variables that are likely to support the uptake of functional technologies (e.g., Weigle,
1997). However, such analyses have not typically made reference to the tradition of the
behavior analysis of cultures, and they have yet to move to a stage of a functional
analysis where the effects of key factors on staff behavior can be demonstrated.
Our position is that common rules and contingencies in mediators’ environments
regulate the structure of developmental disabilities service “cultures.” A consideration of
the role of behavioral principles in cultures has a strong tradition in mainstream behavior
analysis. Skinner (1981) argued that the principles describing the behavior of individual
organisms could be applied, at a more general level, to the analysis of cultures. He argued
that a universal process of selection by consequences can explain the existence of both
individual and group/cultural behavior in the same way that natural selection explains a
person’s biological structure. This view is most clearly seen in Skinner’s concern for the
remediation of social problems and his insistence that the technology of behavior change
could be applied to cultures (Skinner, 1948, 1969, 1971).
Skinner’s concern was mainly with how contingencies could be applied to behavior in
cultures to solve problems, or to the design of utopian environments. If we think
informally about the way that human cultures, such as services for people with
challenging behaviors, function, it would seem that “usual ways of behaving” are
typically transmitted to new members of the group by the use of language. This may be
done by verbalizing rules that describe what to do, or by modelling, which may be
language mediated. Thus, an analysis of the possible role of rules as the units of cultural
transmission, and the question of how rules govern behavior in cultures, is warranted.
Pierce (1991) has suggested three basic approaches to the behavioral analysis of
cultures that could be used in the investigation of mediator behavior. First, observational
research with methods similar to those used by eco-behavioral analysts, including
correlational analyses, could be used to identify possible functional relations. For
example, if data were collected in a continuous fashion (cf. Hall & Oliver, 1992), time
series and lag analyses could be used to identify relations between behavior and its
controlling variables. Second, Pierce suggests using naturalistic experiments where the
natural course of events creates a simple experimental design for the investigation of
independent variables. One potential approach in the analysis of mediator behavior may
be to conduct research on new staff as they become initiated into a developmental
disabilities service. One published case study of a staff member has addressed such a
design (Allen, Chinsky, & Veit, 1974). The young man described in the report recounted
how his attempts to treat the clients in a manner different from the rest of the staff were
met with disdain by his colleagues. This consequence eventually forced the man into
behaving in the “normative” way, and he subsequently resigned.
Pierce’s third research method does offer one possible way of avoiding a reliance on
natural events. He advocates the analysis of behavior of individuals in small groups under
controlled conditions, where contingencies can be introduced and behavior observed.
Because of the nature of this approach, one needs some starting points or hypotheses and
it may be possible to derive these from self-report research (cf. Wahler & Fox, 1981).
With the advent of computer technologies, this method could be extended to the modeling
of key aspects of service environments in a computer-based task with measures taken of
participants’ behavior within the context of a virtual simulation (cf. Hastings et al. 1995).
Conclusions
Contemporary functional assessment and intervention methods have made a
substantial contribution to the quality of life of people with developmental disabilities and
their families. Existing literature is an excellent springboard from which to launch further
research and development. In the present paper, we have selectively presented three issues
for discussion that we hope will stimulate debate and research that will contribute to the
development of work with challenging behaviors.
First, the field has neglected issues relating to how challenging behaviors develop
although there is evidence of increasing research interest in this question. Our existing
behavioral models can be applied to the developmental processes as well as to the
maintaining conditions for challenging behaviors. Therefore, our existing knowledge base
and, to a certain extent, our existing assessment and intervention methods can be applied
to the prevention and early remediation of challenging behaviors. Given the technology at
our disposal and the potential benefits for persons with developmental disabilities and
their families, the question of development is a research priority.
Second, challenging behaviors may be at least partly rule-governed rather than only
contingency-shaped. Existing assessment technologies are based on the premise that
challenging behaviors can be adequately understood using simple contingency-based
models. Our discussion suggests that this assumption may limit the efficacy of current
functional assessment and intervention technologies. A number of implications of
entertaining the possibility that challenging behaviors may be rule-governed were
reviewed.
Third, despite a long and distinguished history of both theoretical and applied work
concerned with mediators of behavioral technologies, mediator behavior has not been
adequately researched in the developmental disabilities field. This is a crucial area for
research and practice if we accept our behavioral models of challenging behavior, which
implicate the behavior of others in its development and maintenance. We explored some
concepts and methods relevant to an analysis of mediator behavior and called again for
more research on this issue.
A final point that is pertinent, and that further links the three issues we have discussed,
relates to the validity of functional assessment and intervention technologies (cf. Carr et
al. 1999). Current technologies have typically been demonstrated to have good internal
validity. For example, Anderson, Freeman and Scotti (1999) found that setting and
temporal generalizability was good for analog assessment methods when challenging
behaviors appeared to serve a single primary function. However, with a case where
challenging behavior appeared to serve multiple or idiosyncratic functions analog
assessments were less robust. Alternative functional assessment methods may be more
appropriate in such circumstances, and further research is needed in order to explore the
fit between different technologies and dimensions of the behaviors being analyzed.
Furthermore, improvements in validity may be gained through the investigation of
methods appropriate to the early development of challenging behavior and to the
understanding of challenging behaviors as rule-governed.
There are still improvements to be made with functional assessment methods
themselves. However, the main challenge for researchers and clinicians is external
validity. Carr et al. (1999) conceptualize this challenge as getting “typical” mediators
(those in day-to-day contact with the person) to conduct functional assessment and
interventions in “typical” settings, rather than through expert consultants in specialized
settings. If there is a priority for future clinically focused research, this is probably the
one.
Along with research more generally on mediator behavior, an explicit focus on issues
relating directly to the adoption of functional methodologies is missing. There is a
literature on the barriers to behavioral intervention (e.g., Corrigan, Holmes, & Luchins,
1993), including research focused on developmental disabilities services (e.g., Emerson &
Emerson, 1987). However, current research has rarely addressed barriers and facilitative
factors in the adoption of functional assessment methods. A notable exception is some
recent research by Hieneman and Dunlap. These authors used a literature review and
qualitative analysis of interview material with individuals involved with PBS to identify
12 factors that may be needed for successful analysis and intervention with challenging
behaviors (Hieneman & Dunlap, 2000). In a further study, they asked 58 clinicians and
parents to rank order these factors revealing a general consensus about the three most
crucial variables (Hieneman & Dunlap, in press): (a) personal investment and focus of
support providers with regard to providing effective behavioral support, (b) capacity of
support providers to utilize the interventions due to their personal resources (e.g.,
knowledge, skills), and (c) flexibility within systems to respond to individual needs.
Staff in some contexts are receptive and enthusiastic about functional assessment and
intervention while others’ negative attitudes and prejudices stand in the way of success. In
the latter context, functional assessment data are often of poor quality and interventions
simply fail. We believe that research needs to address what we call pre-cursors or the
necessary conditions for successful functional assessment and intervention. In this, we are
assuming that clinicians involved will have a threshold level of technical knowledge and
skill, and that existing technologies have good internal validity (although both of these
assumptions should perhaps be tested more explicitly). The pre-cursors or necessary
conditions go beyond these factors and relate to aspects of the mediators, the intervention
environment, and possibly the persons with developmental disabilities and the interactions
between these factors.
Given that most clinicians will have experienced intervention success, intervention
failure (e.g., Scotti, Schulman, & Hojnacki, 1994), and some cases where there is a
mixture between success and failure, their reports may be an excellent starting point for
researchers (cf. Hieneman & Dunlap, 2000, in press). However, the identification of
potentially influential factors is merely the first step in such an analysis. The control of
these factors over caregiver behavior needs to be established, and methodologies
identified from the literature on the behavior analysis of cultures (e.g., Pierce, 1991) may
provide a way forward.
In terms of the implications of our discussion for the practice of PBS, we see three
issues in particular that are worthy of attention by practitioners. First, existing functional
assessment techniques might be used as preventative intervention for challenging
behaviors. In particular, Functional Communication Training may help to prevent
escalation of minor challenging behaviors and, from a theoretical perspective, intervening
as early as possible is likely to be beneficial. Second, language is likely to be a key
variable in selecting assessment and intervention techniques. Practitioners may need to
think creatively in order not to underestimate the complexities of the processes
maintaining challenging behaviors. Finally, PBS already places emphasis on the
mediators of intervention (e.g., Anderson & Freeman, 2000). Our discussion suggests that
there needs to be more of an explicit focus on why caregivers and others might behave in
particular ways. That is, we need a functional analysis of caregiver behavior as much as
we need a functional analysis of challenging behavior. In fact, the two are inseparable.
The establishment of functional assessment and intervention methodologies as they
stand today has been a significant and very important step in the amelioration of
challenging behaviors and improvements in quality of life of persons with developmental
disabilities and their caregivers. However, this is but one step on a very long road. We
should begin to use existing technologies as a base from which to explore some more
complex issues in the understanding and intervention of challenging behaviors.
Acknowledgements
Our thanks go to Joseph R. Scotti for his dedication to the editorial process, and to Linda
M. Bambara and five anonymous reviewers for their helpful comments on earlier drafts
of this paper.
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