Refined Functional Communication Training for Behavioral Issues

Overseen By Serena Claiborne

Age: < 18

Sex: Any

Trial Phase: Academic

Sponsor: Rutgers, The State University of New Jersey

Must be taking: Psychoactive drugs

Disqualifiers: Rett syndrome, Degenerative conditions, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

Duration: 3 weeks

24 Participants Needed

Trial Summary

What is the purpose of 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.

Will I have to stop taking my current medications?

The trial requires that participants be on a stable medication regimen for at least 10 half-lives of each drug or be drug-free. If your medication is stable, you likely won't need to stop taking it.

What data supports the effectiveness of the treatment Refined Functional Communication Training for Behavioral Issues?

Research shows that Functional Communication Training (FCT) is effective for reducing problem behaviors, especially when combined with strategies like extinction or response blocking. Studies also indicate that using multiple FCT responses can help maintain positive communication and reduce problem behaviors. ^{1 2 3 4 5}

Is Functional Communication Training (FCT) safe for humans?

Functional Communication Training (FCT) is generally considered safe for treating problem behavior, as it is an evidence-based practice used for individuals with developmental disabilities. Studies have shown that FCT can effectively reduce destructive behavior without increasing it, indicating a favorable safety profile. ^{1 2 3 4 6}

How is the Refined Functional Communication Training treatment different from other treatments for behavioral issues?

This treatment is unique because it combines Functional Communication Training (FCT) with multiple strategies like stimulus fading and alternative reinforcement, which can enhance its effectiveness in reducing problem behaviors compared to traditional FCT alone. ^{1 2 4 5 6}

Research Team

Wayne W Fisher, PhD

Principal Investigator

Rutgers, The State University of New Jersey

Eligibility Criteria

This trial is for boys and girls aged 3 to 17 who exhibit destructive behavior, like aggression or self-harm, at least 10 times a day despite previous treatments. They must be on a stable medication regimen or drug-free and have consistent educational support with no expected changes during the study.

Inclusion Criteria

You exhibit harmful behavior that happens at least 10 times a day, even after trying different treatments in the past.

If your destructive behavior is only happening to get attention from others, this study may not be suitable for you.

Boys and girls from ages 3 to 17

Exclusion Criteria

Patients who do not meet the inclusion criteria

Patients currently receiving 15 or more hours per week of treatment for their destructive behavior

Patients requiring drug-treatment changes, but the experimenters will invite these patients to participate if they meet inclusion criteria after drug regimen is stable.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive functional communication training (FCT) in various contexts to evaluate the effects of treatment signals and stimulus fading on behavior

3 weeks

Multiple sessions in therapy, home-like, and classroom-like environments

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

Treatment Details

Interventions

• Mult FCT
• Mult FCT + Stimulus Fading
• Trad FCT

Trial Overview The study tests if adding treatment signals and gradually introducing everyday materials can prevent relapse when functional communication training (FCT) moves from clinic to home or is poorly implemented by teachers.

Participant Groups

Group I: Mult FCT/Trad FCT Experimental Treatment 2 Interventions

Participants assigned to this condition will receive both traditional FCT (trad FCT) and FCT with multiple schedules (mult FCT) to evaluate the effects of mult FCT on renewal, super-resurgence, and reinstatement.

Group II: Mult FCT + Stimulus Fading/Trad FCT Experimental Treatment 2 Interventions

Participants assigned to this condition will receive both traditional FCT (trad FCT) and FCT with multiple schedules and stimulus fading (mult FCT + stimulus fading) to evaluate the effects of mult FCT and gradual fading of contextual stimuli on renewal, super-resurgence, and reinstatement.

Who Is Running the Clinical Trial?

Rutgers, The State University of New Jersey

Lead Sponsor

Trials

471

Recruited

81,700+

Findings from Research

Functional communication training (FCT) was evaluated for its effectiveness in reducing problem behavior in three participants, with two showing significant improvement.

FCT was most effective when combined with strategies like extinction or response blocking, suggesting that these methods enhance the training's efficacy in managing problem behaviors.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effects of competing reinforcement schedules on the acquisition of functional communication. Kelley, ME., Lerman, DC., Van Camp, CM.[2018]

In a study involving a child with developmental disabilities, two types of functional communication training (FCT) were tested to reduce problem behaviors without using extinction methods.

The results indicated that using multiple FCT responses to specify desired items was more effective in reducing problem behaviors and maintaining appropriate communication compared to a single response method.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparison of single and multiple functional communication training responses for the treatment of problem behavior. Kahng, SW., Hendrickson, DJ., Vu, CP.[2019]

Response restriction functional communication training (RR FCT) effectively maintained high rates of correct functional communication responses (FCRs) without increasing destructive behavior in children, suggesting it is a safe and effective intervention.

During RR FCT, children demonstrated clear discrimination between FCRs and control cards, leading to near-zero rates of destructive behavior in the final sessions, indicating improved behavioral outcomes compared to traditional multiple schedule functional communication training (mult FCT).

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Decreasing excessive functional communication responses while treating destructive behavior using response restriction. Fisher, WW., Greer, BD., Querim, AC., et al.[2019]

Functional communication training (FCT) is recognized as a highly effective intervention for addressing severe behavior problems, based on extensive research since its introduction in 1985.

The review highlights the emergence of best practices in the FCT treatment process, which can enhance the development and implementation of effective interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Functional communication training: a review and practical guide. Tiger, JH., Hanley, GP., Bruzek, J.[2021]

Functional communication training (FCT) remains an effective treatment for problem behaviors in individuals with intellectual disabilities, as shown in a recent analysis of 58 cases.

The study suggests that combining FCT with alternative reinforcement strategies and using multiple schedules during schedule thinning can enhance its effectiveness, building on earlier findings from 1998.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Functional communication training with and without alternative reinforcement and punishment: an analysis of 58 applications. Rooker, GW., Jessel, J., Kurtz, PF., et al.[2019]

Functional communication training (FCT) is an effective evidence-based practice for addressing problem behaviors in individuals with developmental disabilities, as shown in a systematic review of 37 studies.

However, only six of these studies demonstrated successful maintenance and generalization of behavioral changes, indicating that additional strategies may be needed beyond the natural contingencies of FCT to sustain these improvements.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Generalization and maintenance of functional communication training for individuals with developmental disabilities: A systematic and quality review. Neely, L., Garcia, E., Bankston, B., et al.[2018]

References

1. United States pubmed.ncbi.nlm.nih.gov

The effects of competing reinforcement schedules on the acquisition of functional communication. [2018]

2. United States pubmed.ncbi.nlm.nih.gov

Comparison of single and multiple functional communication training responses for the treatment of problem behavior. [2019]

3. United States pubmed.ncbi.nlm.nih.gov

Decreasing excessive functional communication responses while treating destructive behavior using response restriction. [2019]

4. Switzerland pubmed.ncbi.nlm.nih.gov

Functional communication training: a review and practical guide. [2021]

5. United States pubmed.ncbi.nlm.nih.gov

Functional communication training with and without alternative reinforcement and punishment: an analysis of 58 applications. [2019]

6. United States pubmed.ncbi.nlm.nih.gov

Generalization and maintenance of functional communication training for individuals with developmental disabilities: A systematic and quality review. [2018]