91

3The Cipani Behavioral Classification System

Objectives

• Students will be able to identify the four major diagnostic categories of problem behavior, and define each in terms of the establishing operation (EO) and functional relationship between behavior and its relevant abolishing operation (AO)

• Students will be able to identify the two Direct Access (DA) functions, and define each in terms of the EO, and functional relationship between behavior and its relevant AO

• Students will be able to identify the three Socially Mediated Access (SMA) functions, and define each in terms of the EO, and functional relationship between behavior and its relevant AO

• Students will be able to identify the four Direct Escape (DE) functions, and define each in terms of the EO, and functional relationship between behavior and its relevant AO

• Students will be able to identify the four Socially Mediated Escape (SME) functions, and define each in terms of the EO, and functional relationship between behavior and its relevant AO

• Students will be able to identify the factors involved in deciding the function and diagnostic category of problem behavior, that is, reliable relation between problem behavior and relevant outcome under a given EO, as well as the efficiency of such behaviors relative to other behaviors in producing such an outcome

• Students will be able to delineate how a given topography or form of behavior can be multi-functional

Chapter 3 Behavior Analysis Certification Board (BACB) Task List

4th edition 5th edition • I-05 Organize, analyze, and interpret

observed data

• I-06 Make recommendations regarding behaviors that must be established, maintained, increased, or decreased

• I-02 Define environmental variables in observable and measurable terms

• F-6 Describe the common functions of problem behavior.

• F-9 Interpret functional assessment data.

Cipani, E. P. (2017). Functional behavioral assessment, diagnosis, and treatment, third edition : a complete system for education and mental health settings. Retrieved from http://ebookcentral.proquest.com Created from snhu-ebooks on 2018-10-18 20:51:04.

C op

yr ig

ht ©

2 01

7. S

pr in

ge r P

ub lis

hi ng

C om

pa ny

. A ll

rig ht

s re

se rv

ed .

92 Functional Behavioral Assessment, Diagnosis, and Treatment

This chapter presents a function-based diagnostic classification system for target problem behaviors: The Cipani Behavioral Classification System (BCS). There are four major categories in this system, previously delineated in this text in Chapter 1 and historically (Cipani, 1990, 1994; Cipani & Cipani, 2017; Cipani & Schock, 2007, 2011). These are: (a) Direct Access (DA) 1.0, (b) Socially Mediated Access (SMA) 2.0, (c) Direct Escape (DE) 1.0, and (d) Socially Mediated Escape (SME) 4.0. The Cipani BCS delineates 13 different classifications of behavioral functions under these four major functional classification categories. Each of the 13 individual categories contain either a different behavioral function under a specified establishing operation and/or a different manner in which such a function is produced (direct vs. socially mediated).

The Cipani BCS is a classification system for behavioral functions; it does not categorize forms of behavior or “symptoms.” How is a function-based BCS differ from a more traditional classification system for problem behaviors? The following section identifies the basic characteristics of a function-based classification system.

WHAT IS A FUNCTION-BASED CLASSIFICATION SYSTEM? The characteristics of a function-based diagnostic classification system are the following (Cipani, 1994):

ll Diagnosis of behavior problem characteristics, not child characteristics ll Prescriptive differential treatment derived from a differential diagnosis ll Assessment data collected provides information on context variables, not just rate of

behavior ll Assessment phase concludes with diagnosis phase, in which a function-based category

is selected that best fits the problem behavior’s putative function under the specific EO

Diagnose Behavior, Not Client A function-based diagnostic classification system examines the contextual nature of the problem behavior. It does not presume that the exhibition of behavior is driven by characteristics inherent in the client or child. This sharply contrasts with the current psychiatric approach to diagnosing client behavior (e.g., Diagnostic and Statistical Manual of Mental Disorders [5th ed.; DSM-5]). In a function-based diagnostic classification system, the form of the behavior (in many cases) does not dictate a particular function.

Let us say you have three different children with whom you are involved as a behavioral consultant. Each child engages in a topographically (form) different set of target behaviors. In the traditional psychiatric diagnostic system, each child may receive a different diagnosis because the form of the problem behaviors is different. Because the behaviors or symptoms are different, their presumed cause is assumed to be different. In contrast, a function-based classification of the problem behaviors may reveal that the problem behaviors exhibited by these three children are similar in function, even though topographically dissimilar. Therefore, the classification of these behaviors function using the Cipani BCS could be the same. Using this hypothetical example, let us presume that the functional behavioral assessment obtained data that indicates that all three children’s behavior produces the same reinforcer (i.e., access to tangible reinforcers such as preferred activities). Hence, the function-based diagnosis for all three sets of problems might be subsumed in the same major category. Therefore, despite the obvious individual differences between these children, the prescription for behavior- analytic treatment for this problem area will be similar in composition.

Prescriptive Differential Treatment As just alluded to, a function-based diagnostic classification system also has implications for differential prescriptive treatment. The behavioral intervention designed takes into consideration the function of the problem behavior(s). It is the case that different topographies

Cipani, E. P. (2017). Functional behavioral assessment, diagnosis, and treatment, third edition : a complete system for education and mental health settings. Retrieved from http://ebookcentral.proquest.com Created from snhu-ebooks on 2018-10-18 20:51:04.

C op

yr ig

ht ©

2 01

7. S

pr in

ge r P

ub lis

hi ng

C om

pa ny

. A ll

rig ht

s re

se rv

ed .

3 The Cipani Behavioral Classification System 93

of behavior displayed by a given client can produce the same behavioral contingency if their function is the same. Here is an example.

A child diagnosed with a DSM-5 criteria of Oppositional Defiant Disorder is referred for a number of behavior problems. These problem behaviors include aggressive behavior toward residential staff, noncompliance, and running away from the facility. Aggression, noncompliance, and running away are topographically dissimilar behaviors. Does that mean that different behavioral contingencies should be invoked, depending on which behavior is exhibited at a particular time? Not in the least! If all three behaviors are found to serve the same environmental function, the treatment program would specify the same contingency across the occurrence of any of these behaviors. In other words, irrespective of which behavior occurs, the contingency it would produce (according to the functional treatment plan) would be the same. However, if noncompliance and running away serve a different function than the child’s aggressive behavior, there would be one treatment contingency for aggression and a different contingency for the other behaviors. The specifics of the behavioral treatment are driven by the function of behavior, not by the traditional diagnosis (such is actually irrelevant for functional treatment).

The same behavioral intervention would also apply if different clients or students engage in different forms of problem behaviors, but such behaviors serve the same function. Here is an illustrative example. A child named Susanna, diagnosed with conduct disorder, hits the teacher. A different child named Billy, diagnosed with oppositional defiant disorder, throws a tantrum during class and refuses to follow even simple directions. A third child, Raul, who is diagnosed with attention deficit hyperactivity disorder (ADHD), cries and throws a tantrum when he is prevented from running out of the classroom. Professionals who use a traditional diagnostic classification system presume that each of these three children exhibit different types of behaviors because of their different diagnostic classification. Susanna hits her teacher (and others) because of her affliction with conduct disorders. Billy throws a tantrum because he has oppositional defiant disorder. Raul cries and throws a tantrum because he is impulsive and is incapable of delaying gratification because of his ADHD. If there are three different disorders, should there not be three different treatments, that is, one for ADHD, one for conduct disorders, and so on? Our answer: Not if the different types of behaviors serve the same function (Cipani, 2014)!

Let us say that Raul’s tantrum behaviors and Susanna’s hitting behavior occur when they are denied access to a preferred activity. Both problem behaviors often result in getting the desired activity for each child. Given the same function, the behavioral treatment would be the same. If Billy’s topographically dissimilar problem behaviors are found to produce escape from the task, then the treatment would be designed that addresses that function. But it would be different because of the different function involved (i.e., access vs. escape), not the hypothesized mental disorder! Research studies in applied behavior analysis have failed to demonstrate that certain behavioral procedures work only for children with conduct disorder, or oppositional defiant disorder, and not for those with ADHD, and vice versa.1

In summary, classifying problem behaviors according to environmental function does make a crucial difference in the design of a functional behavioral treatment. In contrast, differential diagnosis using the traditional psychiatric Diagnostic and Statistical Manual of Mental Disorders does not prove fruitful in determining functional behavioral treatments based on syndromes of behaviors.

Assess Context Variables It should now be clear that a useful Functional Behavioral Assessment is concerned with more than just determining the rate of the target behavior. Assessment is driven by the need to determine the environmental factors that are present when the problem behavior occurs, that is, the social and physical environmental context. The effects of both antecedent and consequent conditions of the problem behavior need to be considered. Understanding the role of the client’s antecedent motivational condition at the time makes for a clearer picture of why certain consequent events function as reinforcers at those times. Understanding how certain people may be discriminative for such functions is also important (i.e., socially mediated functions).

Cipani, E. P. (2017). Functional behavioral assessment, diagnosis, and treatment, third edition : a complete system for education and mental health settings. Retrieved from http://ebookcentral.proquest.com Created from snhu-ebooks on 2018-10-18 20:51:04.

C op

yr ig

ht ©

2 01

7. S

pr in

ge r P

ub lis

hi ng

C om

pa ny

. A ll

rig ht

s re

se rv

ed .

94 Functional Behavioral Assessment, Diagnosis, and Treatment

Assessment Phase Concludes With a Differential Diagnosis Phase In the early development of the field of applied behavior analysis, the design of behavioral treatments often did not include a diagnostic phase. The collection of behavioral data often would lead directly to the formulation of a behavioral treatment regimen. In part, this occurred because the word diagnosis was associated with the mental health diagnostic system, which proved useless in the design of behavioral treatments. Given the lack of utility of a traditional diagnosis in prescribing functional behavioral treatments, many early behavior therapists/ behavior analysts have often worked with only two stages of service (i.e., assessment phase and subsequent design of treatment).

We believe that the Cipani BCS serves an important intermediate step. Such an intermediate phase between assessment and intervention would provide for a more guided and deliberate approach to behavioral treatment selection.

WHAT IS THE UTILITY OF A FUNCTION-BASED DIAGNOSTIC CLASSIFICATION SYSTEM? For people naive to behavior-analytic formulations, it may appear that one simply identifies a consequence for a selected target behavior. The selected consequence should be capable of ameliorating the level of the target behavior problem when applied as a contingency. Therefore, the only technical skill needed is to pinpoint the referred problem in observable terms and follow it with an effective consequence. For example, if a referred client is disruptive in an enclave-work environment, first one defines the disruptive behavior in observable terms. Then the professional identifies a consequence to follow the target behavior and specifies the treatment contingency. If this contingency does not work, the professional would select another consequence and design another behavioral treatment contingency.

GOT CONTEXT DATA?

I was involved in a case consultation years ago where a student who was attending a nonpublic school for emotionally disturbed children was being discussed at an interdisciplinary team meeting. Both school and mental health professionals were in attendance at this meeting. Although no actual behavioral assessment data were reported on specific target behaviors, the school and residential staff indicated that his behavior had worsened. They ascribed it to a litany of possible reasons. The reasons ranged from wrong diagnosis (e.g., “I don’t believe he is schizophrenic. I think he is bipolar!”) to blaming his dysfunctional family and his home visits. About 45 minutes went by without any pertinent discussion about specific target behaviors in the classroom. As the meeting was winding down, one of the teachers asked, “OK, what do we do when he acts up?” Somebody volunteered what appeared to be a solution, “Let’s use time-out.” Why was time- out being recommended? Was it important to comprehend that he was from a dysfunctional family, according to some experts? Are students who come from dysfunctional families best treated with time-out? Was it because time-out works best with manic-depressive children (but not, apparently, schizophrenia)? Nothing in the prior discussion had any relation to discussing the behavioral reasons for this proposed treatment. Nor was the rate of target behaviors presented. What was also missing was an analysis of the context under which these target behaviors occur. Further assessment of the contextual nature of the behavioral problems was required.

Cipani, E. P. (2017). Functional behavioral assessment, diagnosis, and treatment, third edition : a complete system for education and mental health settings. Retrieved from http://ebookcentral.proquest.com Created from snhu-ebooks on 2018-10-18 20:51:04.

C op

yr ig

ht ©

2 01

7. S

pr in

ge r P

ub lis

hi ng

C om

pa ny

. A ll

rig ht

s re

se rv

ed .

3 The Cipani Behavioral Classification System 95

Functional behavior-analytic treatment stems from hypotheses about the function or purpose of the target behavior. These hypotheses (classifications or categories of function) are generated from the collection and examination of functional behavioral assessment data. A function-based diagnostic classification of the problem behavior results from the clinician reviewing the information gathered during the functional behavioral assessment process. Such a process is analogous to procedures used in other science-based fields.

For example, in medicine, during an office visit, the physician gathers information about your current medical condition by asking you a series of questions, called a “diagnostic interview.” She or he then obtains other information, possibly from a physical examination as well as individual tests run on medical equipment. The physician then analyzes all the data obtained relevant to your condition and hypothesizes about the cause of your current medical problem. The physician then makes a differential diagnosis. This diagnosis subsequently allows the physician to prescribe a treatment based on that diagnosis. This treatment prescription makes “good sense” given this diagnosis. The treatment for a diagnosis of flu is different from a treatment prescription for a diagnosis of whooping cough. We believe it is just as important in many circumstances to determine the function of the problem behavior to ensure that the behavioral treatment being prescribed is functionally related to the problem behavior.

The remaining text in this chapter will delineate the 13 functions in the Cipani BCS (see Table 3.1) and provide examples of each classification function. For diagnostic criteria for each of these classification categories for use in school settings, the reader is enjoined to read Cipani and Cipani’s (2017) diagnostic manual for the Cipani BCS.

THE CIPANI BCS Cipani (1990, 1994) previously delineated four major diagnostic categories for classifying the environmental function of problem behaviors. The previous editions of this text utilized the same framework in the delineation of the function-based classification system (Cipani & Schock, 2007, 2011).

The following major category functions constitute this classification system:

(1.0) Direct Access (2.0) Socially Mediated Access (3.0) Direct Escape (4.0) Socially Mediated Escape

Within each major category, subcategories are offered. Each subcategory contains the basic characteristics inherent in the major category. The subcategories within each major category are:

ll DA 1.0 Functions l° DA 1.1: Immediate Sensory Stimuli (specify type and location of stimulation) l° DA 1.2: Tangible Reinforcers (specify tangible or class of tangible accessed)

ll SMA 2.0 Functions l° SMA 2.1: Adult Attention (specify which adults/staff) l° SMA 2.2: Peer Attention (specify which peers) l° SMA 2.3: Tangible Reinforcers (specify tangible or class of tangible accessed)

ll DE 3.0 Functions l° DE 3.1: Unpleasant Social Situations (specify situation[s]) l° DE 3.2: Lengthy Tasks/Chores/Assignments (specify length of task) l° DE 3.3: Difficult Tasks/Chores/Assignments (specify task that is difficult) l° DE 3.4: Aversive Physical Stimuli/Event (specify aversive physical stimulus)

Cipani, E. P. (2017). Functional behavioral assessment, diagnosis, and treatment, third edition : a complete system for education and mental health settings. Retrieved from http://ebookcentral.proquest.com Created from snhu-ebooks on 2018-10-18 20:51:04.

C op

yr ig

ht ©

2 01

7. S

pr in

ge r P

ub lis

hi ng

C om

pa ny

. A ll

rig ht

s re

se rv

ed .

96 Functional Behavioral Assessment, Diagnosis, and Treatment

ll SME 4.0 functions l° SME 4.1: Unpleasant Social Situations (specify situation[s]) l° SME 4.2: Lengthy Tasks/Chores/Assignments (specify length of task) l° SME 4.3: Difficult Tasks/Chores/Assignments (specify task that is difficult) l° SME 4.4: Aversive Physical Stimuli/Event (specify aversive physical stimulus)

Category: DA 1.0 Given a deprivation EO, the abolishing operation (i.e., delivery of positive reinforcer) occurs directly through the problem behavior or at the end of a chain of behaviors. In much of the professional literature, this category of behaviors has been referred to as automatic reinforcement (Vaughn & Michael, 1982). Our approach is slightly different from the currently in vogue use of the term automatic reinforcement. The use of the term direct access (and the latter term, direct escape) removes some of the possible misinterpretation of the term automatic. It borrows such terminology from Skinner’s verbal behavioral writings in describing verbal and nonverbal behavior (Skinner, 1957; Vargas, 1988).

We believe there is an advantage to the use of the term direct, in contrast to automatic reinforcement. Using the term direct is defined as behavior that contacts the nonsocial contingency (i.e., physical environment) directly, within a 0.5-second time interval. In other words, the reinforcing event occurs within 0.5 second of the terminal response occurring. If a behavior is maintained by an event that occurs subsequent to this time frame, it is probably not in this category. Further, not all DA functions involve stereotypic behaviors that produce sensory reinforcement as the maintaining contingency (see subcategory 1.2).

There are two subcategories serving DA functions: DA 1.1 Immediate Sensory Stimuli and DA 1.2 Tangible Reinforcers.

DA 1.1: Immediate Sensory Stimuli. Probably one of the greatest advancements in treating difficult problem behaviors exhibited by persons with severe disabilities, such as stereotypic behavior, is the understanding and demonstration that such behaviors may not be socially mediated (Caudery, Iwata, & Pace, 1990; Iwata, Dorsey, Slifer, Bauman, & Richman, 1982; Mason & Iwata, 1990). Problem behaviors in this category produce immediately (often within 0.5 second of terminal response) the sensory event that maintains such behavior. For example, persons who engage in frequent repetitive movements such as hand flapping often do so because of the sensory result such repetitive behaviors produce. Flapping their hands in a certain fashion produces a kinesthetic result that automatically creates its own built-in reinforcer.

Here is another example. Try rocking back and forth in a chair, and note the rhythm produced. Such a chain of behaviors produces a built-in sensory event. This built-in event can function as a reinforcer for the “rocking in the chair” behavior. Such an automatically produced result becomes more desired by persons who cannot create many forms of sensory stimulation due to their cognitive impairments. In contrast, nonhandicapped people are able

TABLE 3.1 n ANALYSIS OF DIRECT ACCESS FUNCTIONS: STEREOTYPIC BEHAVIOR

Establishing Operation (EO)

Behavior Abolishing Operation (direct)

Future Probability of Behavior Given EO

Relative deprivation of sensory event

Engages in specific stereotypic behavior

Produced immediately, reduces deprivation state

More likely

Cipani, E. P. (2017). Functional behavioral assessment, diagnosis, and treatment, third edition : a complete system for education and mental health settings. Retrieved from http://ebookcentral.proquest.com Created from snhu-ebooks on 2018-10-18 20:51:04.

C op

yr ig

ht ©

2 01

7. S

pr in

ge r P

ub lis

hi ng

C om

pa ny

. A ll

rig ht

s re

se rv

ed .

3 The Cipani Behavioral Classification System 97

to watch TV, read a book, listen to music, go on swings, and engage in other solitary activities on occasion. But for nonhandicaped people, occasionally engaging in such activities does not consume one’s entire purpose for the day. However, for persons with disabilities, such stereotypic behavior pervades the entire day and conflicts with alternate essential daily activities and behaviors.

Table DE 3.1 depicts the relationship between the sensory event being in a relative deprivation state (see first column A, Establishing Operation) and the occurrence of the self-stimulatory behavior (second column). Note that the maintaining contingency or abolishing operation is the direct result the behavior produces (third column). Any effect of the behavior on the social environment is inconsequential. The staff or teacher may admonish the client or child after the behavior. However, such a social event is not the purpose of this behavior, even though it may be a reliable contingency of the behavior. It is the sensory result of the stereotypic behavior that will make such a form of behavior occur again when a sufficient state of deprivation is present. Sensory events that can be produced directly through various behaviors can include auditory, visual, tactile, gustatory, and olfactory stimuli.

Many ritualistic (stereotypic) behaviors appear to produce their own immediate kinesthetic reinforcer. Such behaviors often occur independent of the reaction from the social environment. Addictive behaviors, such as smoking and drinking, may also be maintained as a result of their immediate sensory effect. Although this may not describe how such behaviors were developed in the first place, it can explain why such behaviors are still maintained even when the original purpose (EO) is no longer operable. Certainly, for smokers at certain age ranges, social reinforcement and peer acceptance of smoking has diminished tremendously in the last several decades. Yet some people continue to smoke despite the absence of peer reinforcement (and known health risks). Why? For smokers who began the habit years ago, the act of smoking often has its own built-in reinforcer. Table 3.2 provides some questions to consider when entertaining DA to immediate sensory stimuli as a hypothesis.

In Question 1, you should consider whether a one-to-one relationship exists between the behavior and the sensory event. What is the desired sensory event (Question 2)? In some cases, it may be easy to determine the probable sensory reinforcer. For example, someone who sings in the shower is probably reinforced with the auditory result of vocal production in an enclosed area. However, in other cases, it may be difficult to discern what automatic sensory event is the reinforcer. If necessary, an experimental analysis that presents conditions where the sensory effect is ameliorated or eliminated may be the most effective manner of determining such.

www.springerpub.com/fbadt

SMA or DA lecture

ASSIGNMENT

After reviewing the narrated PowerPoint lecture entitled, “Is It SMA or DA?” delineate the test procedures that can be used to isolate the function of behav- iors that appear to be DA, but could also be SMA functions.

For the select target behavior of hair twirling, include in your paper the fol- lowing (in this order):

1. Delineate the procedures for the test condition involving DA function (behavior that produces what contingency).

2. Delineate the procedures for the test condition involving SMA function (behavior that produces what contingency).

3. Generate hypothetical data in a table or graph that displays data for three session for each test condition (six total sessions) in a multielement design, Then explain in text what the results indicate, that is, what function seems verified by the hypothetical data.

Cipani, E. P. (2017). Functional behavioral assessment, diagnosis, and treatment, third edition : a complete system for education and mental health settings. Retrieved from http://ebookcentral.proquest.com Created from snhu-ebooks on 2018-10-18 20:51:04.

C op

yr ig

ht ©

2 01

7. S

pr in

ge r P

ub lis

hi ng

C om

pa ny

. A ll

rig ht

s re

se rv

ed .

98 Functional Behavioral Assessment, Diagnosis, and Treatment

Question 3 addresses the evidence that points to a hypothesis of DA to sensory reinforcement. If the problem behavior is sensory reinforced, it will often occur across most contexts (possibly excluding contexts where punishing consequences have affected the rate). For many clients who engage in self-stimulatory behavior, they engage in such behaviors irrespective of context. If a client engaged in hand flapping only in the context of certain staff, and not others, such a pattern of stereotypic behavior would seem to point to an SMA function. Perhaps some examples of subcategory DA 1.1: Immediate Sensory Stimuli will clarify DA functions representative of this category.

Talking Is Good? I observed a client at a residential facility for persons with disabilities talking loudly to herself while pushing a laundry cart across a parking lot. I looked around and did not see any staff or other people. How can anyone talk or engage in conversation when there is not an audience with which to interact? A traditionally trained mental health professional may surmise that such vocal behavior is directed at an imaginary person. They contend that the client is carrying on a conversation with someone in her mind, who is responding back to her. Although one cannot see what is transpiring inside her cortex, these professionals assume the existence of such on the basis of the carried on conversation. Hence, the client might be hypothesized to be experiencing auditory hallucinations during those incidents.

Is there an alternate explanation? Can such a behavior be maintained in the absence of an audience? Vocal discourse may produce its own reinforcer, that is, auditory (hearing one’s voice) or kinesthetic effect on vocal cords. Certainly, this phenomenon is present in infants who babble for long periods, testing out their newfound ability to generate a sensory effect by vocal production. As I observed this person pushing the laundry cart by herself, that certainly seemed a plausible hypothesis.

How can one determine whether sensory reinforcement is maintaining the client’s vocal behavior? If this behavior occurs when staff are not physically present, and such behavior does not result in their subsequent attention, its function does not seem to be socially mediated. In contrast, if particular staff attend to her in certain ways upon hearing her talking to herself, then subcategory DA 1.1 is probably not an accurate diagnosis for this client. Further evidence of a socially mediated function would be the inability of other behaviors that are in the client’s repertoire to get staff or adult attention when it is available.

Failure to diagnose this as a behavior maintained by sensory reinforcement when indicated may lead to the design of an ineffective treatment strategy. If the vocal discourse produces a DA function, a treatment strategy that involved “ignoring the behavior” would have no effect at all on the rate of this behavior. Intervention of problem behaviors within this category should be aimed at “weaning her off ” of sensory reinforcement or bringing it under control in certain contexts that are not as public (see Chapter 4).

The Voices Make Me Laugh. Here is a similar real-life circumstance. A man, for no apparent reason, would occasionally just burst out laughing as if he had just heard the funniest joke in the world. During an intake at a psychiatric center, he told the professional conducting the assessment that he heard voices in his head. These voices would tell him

TABLE 3.2 n QUESTIONS TO CONSIDER

1. Is there a reliable (every single occurrence) relation between the specific behavior and immediate production of the hypothesized desired sensory event? What is the specific form of the behavior?

2. What seems to be the auditory, visual, tactile, kinesthetic, or gustatory sensation that maintains contingency?

3. What evidence supports the hypothesis that a sensory event is the maintaining contingency? Does this behavior occur across a variety of situations when the client is in a deprived state relative to the sensory event? In other words, does the client engage in this behavior (usually) irrespective of context? Will it occur in the absence of people?

Cipani, E. P. (2017). Functional behavioral assessment, diagnosis, and treatment, third edition : a complete system for education and mental health settings. Retrieved from http://ebookcentral.proquest.com Created from snhu-ebooks on 2018-10-18 20:51:04.

C op

yr ig

ht ©

2 01

7. S

pr in

ge r P

ub lis

hi ng

C om

pa ny

. A ll

rig ht

s re

se rv

ed .

3 The Cipani Behavioral Classification System 99

funny stories and jokes. As a result, this individual was diagnosed with schizophrenia, with “hearing voices” a prime reason for such a diagnosis.

Does he really hear voices? Many mental health professionals would say “yes,” explaining that such voices are a product of his hypothesized neuro-chemical deficits. His mind makes him actually hear voices. Of course, no one can absolutely posit that he does hear voices because the only person who can accurately determine such is this man. The only data regarding this phenomenon is his self-report, which has obvious problems with validity. Is it possible that such a behavior, laughing independent of social input, could be a behavior maintained by reinforcement? As he became a client at the Community Re-Entry Project at the University of the Pacific, Keven Schock and his colleagues would have to answer that question.

How would an analysis of environmental function proceed with such a behavior? First, it was not their intention to actually try to figure out if some internal auditory stimuli were present (currently impossible to deduce). The primary goal was to determine whether the behavior could be socially mediated. To rule out staff (or peer) attention as a possible maintaining contingency, data was collected on the laughing incidents under two conditions: (a) how often he burst out laughing when there were people close by and (b) how often he laughed when he was too far away from people for them to notice him laughing and interact with him. If adult attention were maintaining such a behavior, one would expect to see him engage in this laughter when he was near people, but not involved in social interactions. In addition, if he did engage in such a behavior when away from people, such behavior would recruit their attention.

Therefore, they examined two related sets of data under each condition. First, they examined the number of times he laughed and the total number of minutes he laughed. They found that in this person’s case, if he was left alone and not interrupted, the probability of this behavior was far greater than in the presence of people. In addition, it was noted that such laughter was not frequently resulting in staff attention. In fact, he was perfectly content to be alone while bursting out into laughter. Given this information, it seemed unlikely that his outbursts of laughter were maintained by social attention. This caused them to suspect that for this person, laughing itself was reinforcing.

Could laughing without someone providing a comical situation be a behavior that produces reinforcement in the absence of people? It is similar to the process that many of us go through related to singing in the shower or talking to ourselves. When we sing in the shower, there is generally no one else present to provide attention. Singing in the shower also does not terminate or avoid some aversive situation. Further, most of us would not say that a voice in our head told us to sing in the shower. Therefore, we are left with the only possible function being self-stimulation. So whether it is laughing, singing, or talking to oneself, try to discriminate where you do these self-stimulatory behaviors, but once you are alone, go ahead, I will not tell!

Time-Out Does Not Work? A landmark study in the field of applied behavior analysis involved a study of the effectiveness of time-out procedures with stereotypic behavior (Solnick, Rincover, & Peterson, 1977). It provided evidence that some behaviors produce their own reinforcer. A 6-year-old girl with autism engaged in tantrum behavior. The initial assessment did not reveal the function of this behavior. (Remember this was 1977, and the state of practice and research was not yet investigating behavioral function of target problems.) The researchers tested the effectiveness of time-out on tantrum behavior during

DISCUSSION QUESTION 3A What would you surmise would be the conditions under which laughing at inappropriate times would be maintained by social attention? How would you conduct a trigger analysis of such an antecedent EO (i.e., lack of attention)?

Cipani, E. P. (2017). Functional behavioral assessment, diagnosis, and treatment, third edition : a complete system for education and mental health settings. Retrieved from http://ebookcentral.proquest.com Created from snhu-ebooks on 2018-10-18 20:51:04.

C op

yr ig

ht ©

2 01

7. S

pr in

ge r P

ub lis

hi ng

C om

pa ny

. A ll

rig ht

s re

se rv

ed .

100 Functional Behavioral Assessment, Diagnosis, and Treatment

instructional sessions. In contrast to a baseline, the results were surprising. Time-out did not decrease tantrum behavior. How could that be?

The researchers noted that when this girl was sent to time-out, she engaged in stereotypic behavior, which consisted of weaving her fingers in a pattern. Such behavior was obviously discouraged during instruction. Hence, time-out was the perfect opportunity to engage in such a behavior without impediment. Solnick et al. (1977) then conducted a second study to empirically demonstrate why time-out did not produce a change in tantrum behavior. In the follow-up study, time-out was still a contingency for this girl’s tantrum behavior during instruction. However, the efficacy of time-out was investigated under two different conditions. In one condition, the stereotypic behavior occurring in time-out was left unfettered. In a second experimental condition, such behavior was prevented by immediately restraining her hands upon the initial hand weave. Therefore, in this condition, the hypothesized sensory effect desired was prevented.

The results proved an important point. If time-out resulted in free access to stereotypic behavior (and sensory reinforcement), then the time-out procedure was ineffective at reducing tantrum behavior. However, when such a sensory effect was eliminated, contingent time-outs reduced tantrum behavior. In 1977, these researchers uncovered the possibility that stereotypic behavior was probably automatically reinforced via its sensory effects in many clients with such a problem.

Pica: The Classic Case of Sensory Reinforcement. A male client sticks inedible things in his mouth and gnaws on them (commonly called pica). Many naive personnel may ascribe such behavior of a client to some form of social attention. When asked why the client does that, a staff person responds, “He knows that it upsets me in that I have to go and get it out of his mouth. He likes to see me work.” Putting aside for the moment the employee’s work habits, the purpose of the behavior often has nothing to do with staff. One would not ascribe a baby’s gnawing or mouthing a particular object as a behavior intended to upset his mother or care provider. The same may hold true in this case.

If pica behavior in a particular client is producing its own sensory reinforcer, what could that possibly be? Mouthing of inedible objects produces oral stimulation (probably similar to gum chewing for some people), a sensory event that is the direct result of the behavior. If pica (in this particular case) is serving a DA function, then oral sensory stimulation might be the reinforcer. One should see that such behavior occurs at a consistent rate when left unabated. Attempts to stop it often are met with the client finding contexts in which access to the reinforcer is “under the radar” of the staff. In other words, the client becomes sneaky and stealthy in engaging in this behavior.

In some cases, pica may be socially mediated. However, the form of the behavior is of such a nature that sensory reinforcement should be initially considered when reviewing behavioral assessment data. To rule out social mediation of this behavior, examine the relationship between engaging in pica and SMA to attention via a trigger analysis. Concurrently, also examine the possibility that pica incidents produce SME from relatively aversive events. For example, when the client engages in pica, is the aversive event removed? Is pica a more efficient behavior in getting such a result than other behaviors?

I Like to Bang Against Plexiglas. A hypothetical male adult client with developmental disabilities slaps his hand against the Plexiglas window. Data reveal that this behavior occurs multiple times a day, and he targets the Plexiglas window rather than the stucco wall next to the window. Staff may try to keep him away from the window, but he continues to seek opportunities when they are not as vigilant. When they are not looking, he runs to the Plexiglas window and strikes it with open hand. Staff attribute this client’s destructive behavior toward property to the adult attention he receives upon its exhibition. The staff will scold him and redirect him back to his couch. They will often report, “He likes negative attention. We tell him to stop, but that seems to be what he thrives on, since he goes and does it again at every opportunity.”

If such were true, then removing attention would result in the extinction of window slapping from this client. However, removal of such staff attention does not decrease this daily pattern of behavior. In fact, it only seems to facilitate ad lib access to such and exacerbate the problem. Could it be that such behavior is maintained by the direct result

Cipani, E. P. (2017). Functional behavioral assessment, diagnosis, and treatment, third edition : a complete system for education and mental health settings. Retrieved from http://ebookcentral.proquest.com Created from snhu-ebooks on 2018-10-18 20:51:04.

C op

yr ig

ht ©

2 01

7. S

pr in

ge r P

ub lis

hi ng

C om

pa ny

. A ll

rig ht

s re

se rv

ed .

3 The Cipani Behavioral Classification System 101

it produces? When this client hits the window, a sound of some decibel level is produced. If such a sound is unique to hitting this particular Plexiglas window, it may be this sensory reinforcer is the controlling variable. Maybe it is not the sound that is created, but rather, it is the unique kinesthetic feel of hitting Plexiglas with one’s bare hand. Hitting the wall would not produce the same sensation, which explains why he targets the window. Either way, a desire for attention is not the “driving force.”

What About Kissing and Sex? Distinctive circumstances that fit this category are behaviors that result in sexual (sensory) excitation. Behaviors such as kissing, fondling, and the act of intercourse involve directly contacting a sensory event that follows such behaviors. The DA contingency function involves the behavior/action producing the putative desired reinforcer within a split second; for example, when the lips make contact, the sensory event is produced. This relationship may produce the maintaining contingency, under the relevant EO of deprivation of such stimulation (i.e., a sufficient state of deprivation is relative to each individual). If the functional reinforcer (maintaining contingency) is sensory excitation, such instances of behavior are best categorized as an immediate sensory stimuli DA function.

But such a sensory result is obviously rendered by another person. Why is such a behavior-environment relationship not considered a socially mediated function? In this behavior–reinforcer relationship, the stipulation that the behavior is maintained by its direct relationship with the reinforcer makes such instances a DA function. The other person is not delivering an event or activity that has no direct relationship to the behavior. For example, if upon a kiss, the other person gave the target individual a pizza, the kiss has an SMA function under the deprivation EO related to pizza access. You can say that this hypothetical person kisses someone to get a pizza when he or she wants one. But kissing at some length and intensity serves a DA function when the most powerful existing deprivation EO is a sexual sensory stimulation.

Of course, SMA functions with attendant EOs can also explain some/many incidents of such behavior when occurring under a social/sexual relationship. Someone’s attention and emotional affection can serve as reinforcers (as well as obtaining gifts, etc. as possible tangible by-products of a relationship), given the relevant EOs. Particularly with high school students (but certainly could apply to older persons as well), having a “boyfriend” or “girlfriend” can produce peer attention/approval and peer status. Therefore, in order to determine the function of a given act, (e.g., kissing someone), the relevant EO would have to be identified.

DA 1.2: Tangible Reinforcers. When you want a drink of juice, you may ask someone to get it for you if you are in his or her home. But when you are in your own home, you walk to the refrigerator, pull out the juice bottle, pour it in a cup, and drink. Such a chain of behaviors is reinforced, under the motivational condition of wanting juice (EO), by ingesting the liquid refreshment. For many people, DA to tangible reinforcers is available to them when they engage in a sequence of acceptable behaviors, such as walking to the refrigerator and retrieving a desired food or drink item. In contrast, some clients who reside in residential facilities with other people cannot simply go get something out of the refrigerator whenever they desire something. Facility staff persons may be under orders to prevent ad lib access to food and drink items by clients. Hence, access to such becomes restricted. As mentioned, simply walking to the refrigerator to get a food item is encumbered by staff, but the desire (deprivation EO) still remains in effect! Perhaps running to the refrigerator when staff are not in the immediate area may then develop as a more functional behavior. Subsequently, a referral is made for someone who runs in the facility and attempts to steal food.

DISCUSSION QUESTION 3B Describe the scenario under which such a behavior as hitting Plexiglas would be an SME function? What would staff have to do when he bangs Plexiglas?

Cipani, E. P. (2017). Functional behavioral assessment, diagnosis, and treatment, third edition : a complete system for education and mental health settings. Retrieved from http://ebookcentral.proquest.com Created from snhu-ebooks on 2018-10-18 20:51:04.

C op

yr ig

ht ©

2 01

7. S

pr in

ge r P

ub lis

hi ng

C om

pa ny

. A ll

rig ht

s re

se rv

ed .

102 Functional Behavioral Assessment, Diagnosis, and Treatment

Table 3.3 illustrates the contextual conditions for DA 1.2: Tangible Reinforcer. This DA function is preceded by the existence of a sufficient state of deprivation with respect to an item, activity, or event (first column). This deprivation EO thereby establishes the item as valuable at that point in time. Therefore, whatever behavior(s) is capable of producing the desired item becomes more probable. With respect to this DA function, a chain of behaviors that can result in obtaining the desired item or activity fits this requirement better than other behaviors (next two columns).

Once the item is obtained to a sufficient degree or amount, the prior state of deprivation is abated and the value of the item diminishes at that point. The particular chain of behaviors therefore becomes functional under this deprivation EO and becomes more likely in the future. Note again that any social consequence that may follow this behavior is tangential and is not the maintaining variable or function. The staff may scold the child, place the child in time-out, or engage in other discipline practices. Such practices have nothing to do with the purpose of the behavior. Further, in light of the efficiency of the chain of behaviors to produce reinforcement, such attempts to “correct” the behavior may fail.

If a client wants a piece of chocolate cake and is told “not till after dinner,” pilfering a piece of cake undetected becomes an effective manner of getting cake. Do you have clients who eat their food at mealtime and then begin grabbing the food off their neighbor’s plates, sometimes undetected? If they are adept at pulling this off reliably, such a chain of stealth behaviors becomes strengthened while at the group mealtime. Do they do this for your “negative” attention? Probably not. Your comments regarding their behavior are tangential and inconsequential to the true purpose of this behavior. They would probably be elated if you would turn around and ignore them! They would then have a greater chance to devour a sufficient amount of someone else’s dinner without interruption.

Table 3.4 presents some questions to consider in evaluating a behavior as a DA 1.2: Tangible Reinforcer diagnosis. First, the target problem behavior must have a reliable and

TABLE 3.3 n ANALYSIS OF DIRECT REINFORCEMENT EFFECTS

Establishing Operation

Behavior Maintaining Contingency (AO)

Future Probability of Behavior Under MO

Relative deprivation of tangible item

Chain of behaviors occurs e.g., grabbing, taking item or activity unauthorized

Tangible item produced immediately at the end of the chain, abolishing deprivation state

More likely

AO, abolishing operation; MO, motivating operation.

TABLE 3.4 n QUESTIONS TO CONSIDER FOR A DA 1.2 DIAGNOSIS

1. Is there a reliable, somewhat frequent, direct relation between the problem behavior and getting a desired item or activity? Describe the chain of behaviors.

2. Are the target behaviors more likely to produce the desired items/activities than appropriate behaviors? Are other attempts to access these items or events thwarted? Are the DA problem behaviors thwarted? If so, how often is the client successful relative to other behaviors that may be socially mediated?

3. Does the behavior occur when there exists a sufficient state of deprivation for that client?

4. Are there any special contexts (e.g., during shopping trips, while at home) that make these behaviors more likely?

Cipani, E. P. (2017). Functional behavioral assessment, diagnosis, and treatment, third edition : a complete system for education and mental health settings. Retrieved from http://ebookcentral.proquest.com Created from snhu-ebooks on 2018-10-18 20:51:04.

C op

yr ig

ht ©

2 01

7. S

pr in

ge r P

ub lis

hi ng

C om

pa ny

. A ll

rig ht

s re

se rv

ed .

3 The Cipani Behavioral Classification System 103

frequent relation between the desired tangible reinforcer and its occurrence (Question 1). If  it is a chain of behaviors (often the case), it is the last response step in the chain that produces the tangible reinforcer.

In addition to the reliable relation between the problem behavior and direct production of reinforcer, you should note whether other behaviors are more or less successful in obtaining the desired event (Question 2). The ability of a chain of behaviors to directly produce the tangible reinforcer under sufficient motivational conditions determines the probability of such behaviors, especially when examining how successful (or not) other behaviors are. Question 3 involves examining the antecedent condition to determine if the relevant state of deprivation seems to exist at the time the behavior occurs. Question 4 attempts to discern if there is any special context for such behavior, such as shopping trips or other occasions where a special tangible reinforcer is available.

Breakfast Is Down the Corner. Stealing is a great example of a behavioral pattern that can be maintained by DA to the desired tangible items. It also is often maintained by social peer attention, as is often the case with juvenile delinquents. Knowing which motivating operation (MO) is in effect can lead to a more functionally derived treatment strategy. A foster family I was involved with had several children, all coming from the same mother. One of the boys (Roberto, who was 9 years old at the time) was stealing money and various things from family members as well as from classmates at school. This was apparently a behavioral pattern he picked up early in life when he was with his biological mother. I was told that when the children wanted breakfast, they were told (facsimile of conversation), “The mini-mart is down the street, get to it.” His biological mother felt her children should fend for themselves, hence his early exposure to shoplifting. Once this state of affairs was uncovered, they were removed from their mother. But you can imagine that with insufficient consequences for being caught, and continued practice, Roberto became quite adept at being a frequent usurper of other people’s possessions.

Prior to my involvement, the foster father had tried many strategies to deter stealing. These included pleading with him, discussing society’s prohibition against stealing, appealing to his better judgment, trying to induce guilt and shame over stealing others’ possessions, and grounding him. It would be essential to design a plan that made stealing items not functional (in terms of keeping items). Additionally, getting desired items should be addressed via appropriate channels. If the behavior is maintained because of the items it directly produces, then a program that addresses that function should designate an alternate venue for getting desired items. Reinforcing the absence of stealing would seem to be the way to go in this case.

The plan I came up with involved planting items around the house in conspicuous spots to monitor stealing. I called this the planted item technique, borrowed from researchers Switzer, Deal, and Bailey (1977). Each day the father would place several items, including money, in designated places (unannounced to Roberto). This allowed his father to systematically track stealing by checking each place.

Roberto was informed of the plan the night before it was to go into effect. If all the items remained in their place at the end of the day and there were no other reports of stealing, Roberto received $0.50 for the day. However, if something was missing, the punishing consequences involved the following: (a) return item(s) stolen, (b) lose the stipend amount for that day, and (c) pay a penalty equal to double the value of the item(s) taken. Note that this plan had consequences for stealing as well as for not stealing. I believe the father also threw in early bedtime as well.

As you can imagine, his rate of stealing went down. Stopping this behavior had a profound impact on Roberto’s relationship with both of his foster parents. Probably one of the nicest outcomes of changing Roberto’s behavior happened on one of my visits to the home. His foster mother reported to me an incident in which she was so particularly proud of him. Roberto had returned some planted money to her, saying he found it (planted item) and that she must have lost it. Now that is how you develop a moral compass, a conscience in a child who lacked an upbringing that instilled such values. About a year and a half later, Roberto was still reported to not have a problem with stealing.

Cipani, E. P. (2017). Functional behavioral assessment, diagnosis, and treatment, third edition : a complete system for education and mental health settings. Retrieved from http://ebookcentral.proquest.com Created from snhu-ebooks on 2018-10-18 20:51:04.

C op

yr ig

ht ©

2 01

7. S

pr in

ge r P

ub lis

hi ng

C om

pa ny

. A ll

rig ht

s re

se rv

ed .

104 Functional Behavioral Assessment, Diagnosis, and Treatment

Food Scavenging! Some clients in residential and inpatient facilities have a target behavior listed on their habilitative plan as scavenging. In the case of students with severe disabilities, such may be listed on their individualized educational plan (IEP). Selecting items off the floor and placing them in one’s mouth is a chain of behaviors that can serve a DA function. The food ingestion would seem to be the terminal reinforcing event for the chain of behaviors involved in scavenging. Such scavenging may become more likely after people have finished eating. Again the form of the behavior may change over time as staff become more adept at preventing access to food on the floor by closer vigilance of clients. Successful retrieval of food on the floor may require a quick and stealthy performance to avoid staff detection.

The same behavioral phenomenon exists with some clients who ingest cigarette butts that are thrown on the floor or ground after being smoked. They scavenge areas looking for cigarette butts and will resist staff attempts to physically refrain them from picking up the cigarette butt off the floor. If you believe that this scavenging behavior is socially mediated, try ignoring such attempts to scavenge in a single test session of an in-vivo experiment.2 If the rate stays high or increases, you obviously have not removed the maintaining contingency. You may also receive a “thank you” from the client for allowing unrestricted access to the desired event.

Category: SMA 2.0 Problem behaviors that serve this type of access function obtain the reinforcer through the actions/behavior of another individual. Social attention and interaction from teachers, peers, staff, or parents are all examples of functions in this category. Obtaining preferred food items, toys, or activities can also be SMA functions if such are obtained through the behavior of another person (not directly as previous DA 1.2 category). Within this major category are the following subcategories: SMA 2.1: Adult/Staff Attention; SMA 2.2: Peer Attention; and SMA 2.3: Tangible Reinforcers.

ARE CERTAIN DISORDERS MORE LIKELY TO BE DIAGNOSED WITH SOCIALLY MEDIATED FUNCTIONS?

No, not to the extent that there is any empirical evidence supporting such a contention. For example, to say that persons with intermittent explosive disorder are more likely to have aggressive behavior that is functioning to access adult or peer attention is in opposition to the content of this book. The social environment of each individual determines how certain behaviors affect other people as well as the physical environment. One person with this disorder may yell and scream while at work. Other employees leave the person alone at these times. The function may be avoidance of social interaction at times when it is not desired. Unfortunately, frequent exhibition of such behavior will inevitably result in being fired (long-term consequence). In another person with the same psychiatric disorder, the function of verbal and sometimes physically aggressive behavior may be in the context of a spouse, for example, when the spouse talks on the phone to friends and does not pay enough attention to him or her. Such behavior may be maintained by recruiting desired attention.

The role of a traditional mental disorder diagnosis in a function-based diagnostic classification system is irrelevant at best. While such a diagnosis may be useful in other treatments such as medication, its utility in a behaviorally based system is nonessential. It could often be counterproductive if it sways professional personnel from examining behavioral function.

Cipani, E. P. (2017). Functional behavioral assessment, diagnosis, and treatment, third edition : a complete system for education and mental health settings. Retrieved from http://ebookcentral.proquest.com Created from snhu-ebooks on 2018-10-18 20:51:04.

C op

yr ig

ht ©

2 01

7. S

pr in

ge r P

ub lis

hi ng

C om

pa ny

. A ll

rig ht

s re

se rv

ed .

3 The Cipani Behavioral Classification System 105

SMA 2.1: Adult/Staff Attention. “He does it for my attention! He even likes negative attention.” Not all problem behaviors function to access attention, as some people would have us believe. But in some circumstances, it is true. Problem behaviors that successfully access teacher, parent, or care provider attention are strengthened when the child or client is in need of such attention. Concurrently, other behaviors in the child or client’s repertoire that are less effective or efficient in producing such desired events become weakened. For children, attention from parents, teachers, care providers, or staff at facilities can serve as the function for behavior (both appropriate and inappropriate) under a deprivation EO with respect to such attention. For clients in facilities, staff attention is sometimes the maintaining variable in target undesired behavior. A descriptive analysis for this subcategory is given in Table 3.5.

Table 3.5 illustrates that behaviors that serve this function occur when the EO for attention is great (column A). This sets up the conditions for the client to be “motivated” to obtain such (given someone who is discriminative for providing attention for some displayed behavior). The occurrence of the behavior (column B) at some frequency or duration produces the desired form of attention (column C), thus making it functional under those antecedent conditions.

The form of behavior that results in adult attention is determined by the specific social environment. For example, in one situation, a smile from a man may evoke eye contact and a smile back from an interested female walking past this man. However, the same smile from this man has no effect on another woman next to whom he sits down. Later on, the same behavior from this man results in a frown of disgust from a married woman in the restaurant. If the smile produces a fair number of acceptable social responses, this man is more likely to smile than exhibit other behaviors when seeking someone’s attention. As a side note, certain elements/stimuli of the social context may develop discriminative properties over this man’s behavior for someone’s attention over time. For example, he may learn to smile only when the female shows initial interest (i.e., makes eye contact with him).

Problem behaviors maintained by adult attention can take many forms, from innocuous minor behaviors such as giggling, to behaviors that cause great disruption, such as severe tantrums, aggression to others, and running away. For attention to be the function, the problem behavior should reliably produce teacher attention under the relevant deprivation EO, and this temporal relationship should be observed. For example, in the face of a child wanting attention, the problem behavior becomes more effective or efficient at getting the adult’s attention than other behaviors, either desirable or undesirable. Table 3.6 specifies factors to examine when considering an adult attention hypothesis.

TABLE 3.5 n ATTENTION FUNCTION

EO B Contingency (AO)

Absence of attention for a sufficient period of time

Behavior occurs (at some frequency and/or duration)

Adult attention (delivered in some form)

AO, abolishing operation; EO, establishing operation.

TABLE 3.6 n QUESTIONS TO CONSIDER FOR AN SMA 2.1 DIAGNOSIS

1. Is there a reliable, somewhat frequent relation, between the problem behavior and teacher, staff, or parent attention? What is the form of the behavior?

2. Are the target behaviors more likely to produce attention than other more acceptable behaviors?

3. Does the behavior occur in the absence of attention and a sufficient state of deprivation (relative) exists?

Cipani, E. P. (2017). Functional behavioral assessment, diagnosis, and treatment, third edition : a complete system for education and mental health settings. Retrieved from http://ebookcentral.proquest.com Created from snhu-ebooks on 2018-10-18 20:51:04.

C op

yr ig

ht ©

2 01

7. S

pr in

ge r P

ub lis

hi ng

C om

pa ny

. A ll

rig ht

s re

se rv

ed .

106 Functional Behavioral Assessment, Diagnosis, and Treatment

An attention function involves a reliable relation between the problem behavior and access to desired attention (Question 1). Although the target problem behaviors may have to occur at some frequency and duration, such problem behaviors are more successful at getting attention than other more acceptable behaviors (Question 2). Further, the target problem behavior occurs in the absence of attention, where a sufficient state of deprivation exists (Question 3). Let us examine possible scenarios of problem behavior representative of this diagnostic category.

I Want Your Attention, NOW! A hypothetical student, Dolly, is referred for consultation as a result of whining and tantrum behavior in a primary elementary grade class. The teacher reports to you that this student is simply immature for her age. Dolly spends part of her day in general education and the remainder in a special education resource room. The general education teacher states that these tantrum behaviors can occur unexpectedly; “whenever Dolly is in a bad mood. You never know when she is in a bad mood!”

You schedule a 50-minute consultation visit and prepare to identify the context under which tantrum behaviors occur. Using direct observation and determining what EO seemed to be present at the time of the “tantrum incident,” you view the following in a session involving teacher lecture and independent seat work. Tantrum behavior did not occur during teacher-delivered instruction. Rather, it occurs during seat work. Dolly would work for a while without any problems. However, when tantrums did occur, the context seemed to involve the following. Dolly would raise her hand to obtain teacher attention. Unfortunately, such requests frequently go ignored for some period of time because the teacher is often working with someone else. Hand raising is not an effective or efficient manner to get the teacher’s attention at these times. This is not making a social judgment, but rather an empirical observation. This situation also leads to a strengthening of the EO for attention relative to other needs. Getting teacher attention becomes an even higher priority with Dolly when this happens. However, when Dolly hits her desk with her hands while concomitantly whining and complaining, the teacher first tells her to stop. However, shortly thereafter, the teacher comes to her desk to “find out what all the fuss is about.” With this offering of help by the teacher, Dolly then proceeds to calm down and begin her seatwork (and the teacher provides her help and encouragement).

When this student wants the teacher to come over to her, what are her options? Raise her hand? Selecting that option results in a longer protracted wait. Bang on the desk? That option produces faster results; hence, that form of behavior becomes strengthened under the conditions of wanting teacher attention.

In this case, there is another question one has to ask and answer. Why is teacher attention in some form of deprivation in the general education class, but not in the resource room (tantrum behaviors not reported to be a problem in this setting). Observation of the two classrooms will reveal the reason. You realize that in this student’s resource room there may be 6 to 11 children at any one time. Therefore, needing teacher attention is not as lengthy a wait as in the general education class. In the general education class, 25 other students have needs as well. Dolly’s access to teacher attention is markedly less. Hence she engages in behaviors that are hard to ignore, but unfortunately will result in her loss of placement in mainstream settings.

I Am on the Phone! How many times have you seen (or been the recipient of) a child screaming, “Mom, I need to talk to you!” while Mom is on the phone or engaged in conversation? Interrupting behaviors occur because they are more successful under those conditions than other more desirable behaviors. The child may tug on Mom’s shirt, but to no avail. However, a loud scream produces several responses from Mom. Let us look at a scenario depicting what transpires that makes screaming an adaptive response for this child when Mom is busy with someone else.

Child: Mom, I need you (in conversational tone while pulling on her shirt). Mom: Wait just a minute; I am on the phone with your sister. She is at the dentist. Child: (after several minutes go by): Mom, I need to get some juice. I am losing my

voice from lack of liquid.

Cipani, E. P. (2017). Functional behavioral assessment, diagnosis, and treatment, third edition : a complete system for education and mental health settings. Retrieved from http://ebookcentral.proquest.com Created from snhu-ebooks on 2018-10-18 20:51:04.

C op

yr ig

ht ©

2 01

7. S

pr in

ge r P

ub lis

hi ng

C om

pa ny

. A ll

rig ht

s re

se rv

ed .

3 The Cipani Behavioral Classification System 107

Parent: Hold on, I will only be another minute. Child: (several minutes go by, child screams): Well I will just get it myself. I have to do

everything myself. Nobody cares about me! Mom: OK, I am coming (and terminates conversation).

As you can see, the child escalates his or her demanding when minor forms of demands for Mom’s attention are not fruitful (which is very often the case with phone conversations). Ignoring these minor forms then makes the screaming bout at the end more likely, with Mom terminating the conversation shortly and attending to the child. The child’s level of screaming under conditions where attention is wanted has just been strengthened. Of course, many more scenarios similar to this play out over time to develop a reliable contingent relation between the form of screaming and accessing Mom’s attention.

A Pinch Here, a Pinch There. An adult male client with severe mental retardation who has no vocal speech would pinch people as they passed by him. It was easy for me to discern who this client was upon entering the building without anyone pointing him out. As I entered the building I could see him sitting at a table. Nothing striking there, right? Upon observation, adult staff at his day treatment program would near his table area and then move in a semicircle away from him in order to get to the other side. Now you know why it was easy to figure out who this client was without someone pointing him out.

Occasionally, even with staff winding a long arc around his area, he would be successful in pinching people. If someone got too close, he would dart out of his seat and pinch that person. Of course, new persons on the floor had to be warned about such a behavior in order to engage in the protocol for avoiding him. As you could imagine, this “imposed circle of avoidance” made attention even more desired from this client’s perspective. As staff became more successful at avoiding him, the rate of attention from staff became less and less. The more successful the staff persons were at avoiding him on a given day, the greater the deprivation EO became, making attention even more valuable.

To compound matters, staff members were instructed to engage in the following contingency upon being pinched by this client. They were to immediately say “No pinching,” and then proceed to his hand, shake it, and say, “This is what we are supposed to do.” The program designer probably thought that this would teach him how to initiate acceptable social interactions with staff. Instead of pinching, he would offer to shake hands. Wrong on that count. Let us examine all the behavioral contingencies in place for this client. When he simply sits in his seat, people avoid him so that he will not pinch. Nothing in the program design mentions to catch him when he is not pinching and prompt the acceptable behavior! But, when he does pinch, he gets some brief interaction with people in this correction procedure. Pinching successfully ensures him staff attention as the staff adhere to this program. Pinch away!

“I Will Kill Myself!” When someone in a mental health facility makes this statement, his or her environment is guaranteed to change. Protocol requires that a number of staff interactions, interviews, and assessments be conducted to determine the dangerousness of such a verbal statement. Such traditional assessments often revolve around determining whether the person is depressed to such a level that killing oneself is an option he or she might entertain. Of course, all instruments that could be used for committing suicide are made inaccessible. Staff members are intensely vigilant in these circumstances to ensure that such items are not attainable. Such efforts are certainly mandatory in the case of protecting life.

Could an analysis of behavioral function be of utility in separating out those persons whose life is in immediate danger from others? What possible behavioral function could such threats serve? Could such threats to kill oneself be under control of social reinforcers? If so, why would some people need to go to this extreme (stating they are going to kill themselves) to get such reinforcers? Although not discounting the possibility that some people obviously commit suicide because they feel (at that time) life may not be worth living, a functional evaluation of verbal statements may prove useful in designing treatment.

Let us take the case of someone who has just lost a spouse through an abrupt death. In a state of depression, the person contacts a mental health crisis center. Contingent upon saying

Cipani, E. P. (2017). Functional behavioral assessment, diagnosis, and treatment, third edition : a complete system for education and mental health settings. Retrieved from http://ebookcentral.proquest.com Created from snhu-ebooks on 2018-10-18 20:51:04.

C op

yr ig

ht ©

2 01

7. S

pr in

ge r P

ub lis

hi ng

C om

pa ny

. A ll

rig ht

s re

se rv

ed .

108 Functional Behavioral Assessment, Diagnosis, and Treatment

that suicide is an option as a result of his or her grief, the person immediately interacts with many different professional people (e.g., doctors, nurses, social workers, front-line support staff, and therapists). In a time of need, these professional people are very supportive and caring, and the client possibly begins to reevaluate his or her life in new ways. As this person’s mental health is evaluated as improving, the client sees these people less and less over time. For some people that may not be a problem because they have other people in their social network to return to. People with friends and relatives can be provided the care and support one needs to face difficult life-altering circumstances. But what about those people who have lost the one friend they had? To whom do they turn? If there is no one left, or their relatives live far away, they return to emptiness (in terms of social network). For these people, getting “better” results in a significant decrease in social interactions (adult/staff attention). The better they are, the less contact they have with people.

It is important to address why a functional evaluation is just as essential as traditional diagnostic evaluations of persons in this circumstance. A traditional view begins with the assumption that verbalizing the statement “I feel I might kill myself ” is a symptom of depression or low self-esteem. Given that view, the professionals involved will “pull-out all stops” to make this person less depressed. They will probably provide antidepressant medications and increased professional services (including individual and group therapy). What this regimen establishes has both short- and long-term ramifications. First, after receiving such services, the person does feel better, that is, less depressed. That is the short- term result of such statements, which is essential. Additionally, such statements proved to be very effective in recruiting social interaction when desired. If social interaction and attention is less available for the client once released from the inpatient setting, the EO for attention develops over time. Hence, the longer the client goes without social interactions while in the community, the more likely such statements can occur. This process, in effect, establishes a cyclic pattern of improving and worsening. The functional utility of such statements in accessing attention, as well as the person’s loss of attention from professionals as he or she gets better, needs to be considered if we are to develop more effective interventions for people diagnosed with mental illness.

If mental health systems take such a possible function into account, would it replace the current system? Absolutely not! People who say they are going to commit suicide need attention! It is currently impossible to determine with great reliability and precision who is likely to follow through with this threat and when. However, what a functional analysis will add to the comprehensive treatment of these people is the concurrent development of a social network for them when they leave the facility. Perhaps developing conversational skills as well as social trips to local community centers while they are inpatients would be therapeutic. Making new friends and contacts would be a treatment objective. Professionals would spend as much time in developing these clients’ new circle of friends as they would in triaging the presenting complaint. In short, giving such a person many reasons to live is the best long- term approach, one facilitated by a functional analysis of the maintaining contingencies.

Will Steal for Social Attention. A 12-year-old female living in a foster home was referred to Keven Schock. The psychiatric staff were considering putting her on psychotropic medications due to her diagnosis of kleptomania. The referral was to determine if she could control herself in this matter or if it was purely neurological (hence the need for medication as the only effective solution). This young woman would steal daily, often items that were of no real value to her. Among the items reported to have been stolen were a broken pencil, other students’ school work, a kitchen egg timer, and even a pair of dentures! Now most people would assume that the reinforcer for stealing is the DA to the desired item (i.e., DA 1.2: Tangible Reinforcer).

In this case, that diagnosis did not fit. The items she stole were not items used by her. They served no purpose in her life. So why might someone steal items that were of no use to him or her? Keven asked one of the staff persons, “What does she do with these items?” The staff person’s reply was, “She leaves them on her desk in her room. I think she must be psychotic or something. She does not have any sense to hide them. She leaves them where she knows I will find them.”

Could it be that this person desires to get caught? But why would someone want to get caught? Is such a purpose best explained by invoking an existential crisis theory? When

Cipani, E. P. (2017). Functional behavioral assessment, diagnosis, and treatment, third edition : a complete system for education and mental health settings. Retrieved from http://ebookcentral.proquest.com Created from snhu-ebooks on 2018-10-18 20:51:04.

C op

yr ig

ht ©

2 01

7. S

pr in

ge r P

ub lis

hi ng

C om

pa ny

. A ll

rig ht

s re

se rv

ed .

3 The Cipani Behavioral Classification System 109

Keven asked staff what happened when she got caught, the reply was illuminating. “I punish her by giving her long lectures on how bad it is to steal, but it just isn’t working, I think she has low self-esteem and wants to be punished” (there you go, an existential crisis). Perhaps she is a masochist!

Can an analysis of behavioral function support another explanation (one rooted in some form of reality)? Perhaps she desires attention, in whatever form. Consider this hypothesis. If she had minimal ability to initiate interactions, she might be forced to rely on another behavior to interact with people. Her stealing did not seem to be a function of access to tangible reinforcers. It also did not occur under conditions that would promote escape or avoidance behavior. Rather, it was her most effective way to access adult attention.

SMA 2.2: Peer Attention. This diagnostic category encompasses problem behaviors that gain desired peer attention, particularly when peer approval is a powerful reinforcer, that is, presence of deprivation EO. This function exists more frequently in school settings with adolescents (e.g., class clown phenomenon) but can be operable with other clients where peer attention is a desired event.

In order for peer attention to function as a maintaining contingency for target problem behavior, peer attention has to be available. Given that children, adolescents, and adults can transmit information regarding the display of behavior, peers can either be physically present (e.g., in the classroom at the time of the behavior) or be able to be informed of the incident. But peer attention is not solely a function that is endemic with adolescents. It can also be a powerful motivating condition for adults as well. For example, some adults engage in behavior that recruits peer attention or approval as well (e.g., man or woman who “brags” about sexual conquests to buddies, or brags about other phenomena that recruit approval from peers). Other examples for adults can include the “necessity” to buy certain types of items such as cars, clothing, and so on to achieve or maintain some form of social status (i.e., peer attention).

Behaviors that reliably access peer attention become strengthened, particularly in social environments where peer approval is a powerful reinforcer. Problem behavior maintained by peer attention might be hard to detect because the approval or attention of peers may not occur immediately. In fact, with older children, some problem behaviors are reinforced by peers at a later time when they find out about the misbehavior (e.g., aggressive or disruptive behavior).

This function involves a reliable relation between the problem behavior and the access to desired peer attention. Other more acceptable behaviors are less likely to result in peer attention. Although the target problem behaviors may occur sometime before certain peers become aware of the incident or behavior, the delayed result still maintains the behavior. Teacher or adult attention may occur much closer to the problem behavior but may not be a factor in its maintenance (deprivation EO for adult attention not operable). Very often, an incorrect hypothesis about such behaviors in this subcategory being maintained by adult attention leads to an ineffective strategy. The following examples illustrate this point.

Everyone Loves a Clown (Except the Teacher). An example of problem behavior maintained by peer attention is a hypothetical junior high school special education student, Billy. He is referred for a functional behavioral assessment for his verbally inappropriate behavior toward teachers. Following is a sample of what transpires during an incident of inappropriate verbal behavior during a prealgebra class.

Teacher: Who can tell me what a linear equation is? Billy: (somewhat covertly, although within earshot of other students) What a bore. Teacher: Billy, do you have something to contribute to this discussion? Billy: I said what a core concept! (other students start giggling) Teacher: Perhaps you would like to teach this core concept. Billy: What for! (class breaks out laughing, Billy is sent to the principal’s office)

It is not difficult to surmise that such behavior is resulting in peer attention. When Billy makes such comments to the teacher, he gets the attention and approval of his fellow

Cipani, E. P. (2017). Functional behavioral assessment, diagnosis, and treatment, third edition : a complete system for education and mental health settings. Retrieved from http://ebookcentral.proquest.com Created from snhu-ebooks on 2018-10-18 20:51:04.

C op

yr ig

ht ©

2 01

7. S

pr in

ge r P

ub lis

hi ng

C om

pa ny

. A ll

rig ht

s re

se rv

ed .

110 Functional Behavioral Assessment, Diagnosis, and Treatment

classmates. For a trip to the principal’s office, he now becomes the most popular kid in the class. He has peers wanting to hang out with him during recess and at lunch. Such peer attention and approval can often override the power of designated discipline strategies such as dismissal from class. It is important to diagnose these problems as SMA 2.2: Peer Attention in order to provide effective intervention.

It is important to note that while some people may view the teacher’s attention as the maintaining variable, such is not the case. Without peer attention that followed teacher attention, the level of the problem behavior would be much weaker. This is not to say that the teacher’s response to Billy’s initial smart remark did not provide the perfect forum for this student. It set the stage for peer attention to become more pronounced.

Suppose the teacher attended to other behaviors of this student that do not result in peer attention, such as raising his hand to be recognized. Would such have an effect on inappropriate verbal behavior? Many people, naive to an understanding of behavioral function, would vehemently respond with “Yes.” From what you know now, why would a change in this student’s behavior probably not happen?

Class Clown: It’s Elementary. A hypothetical second-grade girl engages in a number of inappropriate behaviors, such as sticking her tongue out at the teacher (when the teacher is not looking), dropping her pencil, and making faces. Despite the fact that the teacher admonishes her for engaging in such behaviors, the peer reinforcement for such behaviors is far stronger than the admonishment she receives. She becomes the most popular student on the playground during recess. Subsequently, the rate of these behaviors is maintained at a high level as a result of their ability to get peers to attend and laugh with her.

SMA 2.3: Tangible Reinforcer Hypothesis. We have all seen children at the supermarket whine, cry, and throw a tantrum. Are they possessed by demons? Many people will comment that they probably want something from their parents. Very often, they are right. They have assessed the motivational condition correctly. What is also true is that this set of behaviors has been successful in the past in obtaining such desired items or activities. As a result of the adult’s mediation of such undesirable behaviors, they become more probable, and more appropriate behaviors that are ineffective at getting the desired item become less likely. In contrast to the DA category, DA 1.2, the client’s target behavior does not directly produce the item. The undesirable behaviors (at some level or duration) are mediated by a parent providing the item contingent upon the behavior. The delivery of this reinforcer makes such target problem behavior much more likely when the EO for a given item in future shopping trips at the store becomes strengthened.

Therefore, target problem behaviors that function to access a desired tangible item, object, event, or activity under a deprivation (EO) are strengthened (see Table 3.7). Further, other behaviors (perhaps more desirable) in the child’s or client’s repertoire that are ineffective or inefficient at producing such events become weakened.

In many cases, target behaviors functioning in this subcategory are usually misdiagnosed for problems maintained solely by adult attention (SMA 2.1). This can easily happen if one simply watches the first socially mediated event following the target behavior. For example, let us say that a student in a special day class for mild disabilities refuses to line up for adaptive physical education (PE). As a result, the teacher quickly moves until in close proximity to the student and may say something. If one assesses that the first social event that occurred subsequent to the behavior is the maintaining variable or function, one would classify this problem as an SMA 2.1, given a reliable relation between these events. However,

TABLE 3.7 n TANGIBLE REINFORCER FUNCTION

EO B Contingency (AO)

Absence of item or activity for a sufficient period of time AO, abolishing operation; EO, establishing operation.

Behavior occurs (at some frequency and/or duration)

Item or activity delivered in some form by someone

Cipani, E. P. (2017). Functional behavioral assessment, diagnosis, and treatment, third edition : a complete system for education and mental health settings. Retrieved from http://ebookcentral.proquest.com Created from snhu-ebooks on 2018-10-18 20:51:04.

C op

yr ig

ht ©

2 01

7. S

pr in

ge r P

ub lis

hi ng

C om

pa ny

. A ll

rig ht

s re

se rv

ed .

3 The Cipani Behavioral Classification System 111

after some protracted discussion, the teacher bribes the student to get in line by allowing her to carry her favorite doll while she goes to PE. Now you know the whole story!

The problem in accurately diagnosing behavior problems in this category is that the delivery of the desired event or item will also coincide with adult attention. This is always true because access to the item is socially mediated. However, one should recognize that adult attention is an incidental variable and that access to the item, activity, or event is the “driving force” for the behavior. This can be tested in an in-vivo hypothesis test comparing two conditions. In half the sessions, present only attention and praise for this student when the child gets in line. In the other sessions, provide the desired item if the child gets in line within a certain time. If the item is the power behind the maintaining contingency, guess what condition will result in the child getting in line more frequently?

The problem behavior may have to occur over some period of time before the adult provides the event or activity. In the case of children, the care provider or parent may initially attempt to ignore such behavior and not “feed into it.” The parent refuses to give the child what he or she wants. Such initial attempts at ignoring the behavior do not result in the problem behavior ceasing. Rather, the problem behavior escalates in form and duration. As a result of the child’s behavior worsening, the adult, under pressure (and wanting to now stop the behavior at all costs), gives the child the object or activity. It is essential to detect such a shaping of different exacerbated forms of problem behavior and durations by the parent’s response to both the initial form as well as the more severe form.

Sometimes the presentation of the tangible reinforcer is done in a manner that looks like the teacher, parent, or care provider is reinforcing appropriate behavior (e.g., “If you’re quiet for 5 seconds, then I’ll let you go outside and play.”). The child engages in appropriate behavior and subsequently is given the desired item. However, one should realize that the entire chain of problem behaviors has led to the client’s access to the item. It is not simply a matter of what behavior occurred prior to the delivery of the item! Table 3.8 presents questions to pose when considering this diagnostic subcategory.

This function involves a reliable relation between the problem behavior and the access to the desired item or event (Question 1). Other more acceptable behaviors are less likely to result in the desired item or activity (Question 2). Although the target problem behaviors may have to occur at some frequency or duration, they are more successful at getting the desired item or event than other more acceptable behaviors (Question 2). To reiterate, attention and other events may occur in the interim between behavior onset and delivery of socially mediated tangible reinforcement. Do not assume the events that are temporally closer to reinforcement are maintaining the behavior! Rather, in some cases, it is the ultimate delivery of the tangible reinforcer that is the driving force behind the client’s behavior. Let us examine possible examples of problem behavior serving this diagnostic category.

Elopement. A female client was frequently running naked down the driveway of a residential facility. Staff reported that this occurred at least twice a week. Several staff would follow her and try to talk her into coming back. Obviously being naked will result in adult attention, both from staff and passersby. But such attention alone did not seem to explain this periodic nude display in the neighborhood. The staff indicated that this client was perfectly capable of accessing attention from staff, multiple times during a given day. Further, on a

TABLE 3.8 n QUESTIONS TO CONSIDER FOR AN SMA 2.3 DIAGNOSIS

1. Is there a reliable, somewhat frequent relation between the problem behavior and SMA to the tangible item or event? What is the form of the behavior?

2. Are the target behaviors more likely to produce access to the item or event than appropriate behaviors?

3. Does the behavior occur under a sufficient state of deprivation, that is, relatively protracted absence of item, event, or activity?

Cipani, E. P. (2017). Functional behavioral assessment, diagnosis, and treatment, third edition : a complete system for education and mental health settings. Retrieved from http://ebookcentral.proquest.com Created from snhu-ebooks on 2018-10-18 20:51:04.

C op

yr ig

ht ©

2 01

7. S

pr in

ge r P

ub lis

hi ng

C om

pa ny

. A ll

rig ht