Refinements of Functional Communication Training
Trial statusRecruiting
Trial phaseNot applicable
Trial typeInterventional
Biological sexAll
Age3-17
SponsorRutgers, The State University of New Jersey
About this trial
Although treatments for problem behavior, like functional communication training (FCT), can be highly effective in the clinic, changes in the way the FCT is implemented (e.g., when transferring treatment to the home, when teachers implement treatment with poor fidelity) can result in treatment relapse. The goal of this study is to evaluate whether using treatment signals and gradually introducing materials from natural contexts can help mitigate treatment relapse during context changes and poor treatment-integrity scenarios.
Eligibility criteria
This trial does not accept healthy volunteersQualifiers
Boys and girls from ages 3 to 17
Destructive behavior that occurs at least 10 times a day despite previous treatment
Destructive behavior reinforced by social consequences like attention (FCT is not appropriate for automatically reinforced destructive behavior)
On a stable psychoactive drug regimen for at least 10 half-lives per drug or drug free
Disqualifiers
Patients who do not meet the inclusion criteria
Patients currently receiving 15 or more hours per week of treatment for their destructive behavior
DSM-5 diagnosis of Rett syndrome or other degenerative conditions (e.g., inborn error of metabolism)
A comorbid health condition or major mental disorder that would interfere with study participation
Trial design
Design model
Parallel
Treatments tested in this trial
Trad FCT
BehavioralThis intervention emulates a traditional reinforcement schedule-thinning method during FCT in which clinicians program delays to reinforcement without discriminative stimuli (e.g., the child learns that some FCRs result in reinforcement and some do not). By programming reinforcement approximately every 15 s, the rate of reinforcement will be equivalent to mult FCT. During Period 1 of this project, trad FCT served as an appropriate control condition to which mult FCT could be compared.
Mult FCT
BehavioralThis intervention involves correlating discriminative stimuli (e.g., purple and yellow index cards) with times in which reinforcement for the functional communication response (FCR) is and is not available. During Period 1 of this project, this procedure resulted in rapid reduction of destructive behavior and mitigated resurgence and renewal when the discriminative stimuli were used as programmed.
Mult FCT + Stimulus Fading
BehavioralThis condition is similar to mult FCT except that the experimenters will gradually incorporate natural stimuli (e.g., rugs, tables, lamps) into sessions to approximate target settings that may occasion relapse typically without such gradual stimulus fading.
Treatment groups
24 Participants
are divided into 2 treatment groupsGroup A: Mult FCT/Trad FCTExperimental treatment 2 interventions
Group B: Mult FCT + Stimulus Fading/Trad FCTExperimental treatment 2 interventions
Trial outcomes
Primary outcomes
1
Rate of Destructive Behavior in Renewal Test
The investigators will measure the rate of destructive behavior following successful treatment when the FCT is implemented in a context not associated with treatment (e.g., the baseline, home-like context).
Time frame
Through study completion, an average of 3 weeks.2
Rate of Destructive Behavior in Super-Resurgence Test
The investigators will measure the rate of destructive behavior when FCT is implemented in a context not associated with treatment (e.g., a classroom context) by an implementer who fails to reinforce the communication response. This would be similar to a busy teacher in a classroom who is unable to attend to the child due to assisting another student.
Time frame
Through study completion, an average of 3 weeks.3
Rate of Destructive Behavior in Reinstatement Test
The investigators will measure the rate of destructive behavior when FCT is not implemented as prescribed (i.e., reinforcement is delivered on a time-based schedule, rather than following communication responses). This would be similar to a teacher who delivers breaks from work based on the school schedule (e.g., switching from math to reading) rather than the child's request for a break during the math period).
Time frame
Through study completion, an average of 3 weeks.Sponsors and contacts
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Source ClinicalTrials.gov