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

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores ways to improve treatments for problem behaviors in children and teens, especially when transitioning from a clinical setting to home or school. The goal is to determine if strategies like treatment signals and gradually introducing everyday items can prevent these behaviors from recurring. Participants will test different methods of functional communication training (FCT) to identify what works best in various situations. This trial suits children aged 3-17 who experience destructive behavior, such as frequent tantrums, that hasn't improved with standard treatment. As an unphased trial, it offers participants a unique opportunity to contribute to innovative approaches that could enhance treatment effectiveness in everyday environments.

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 prior data suggests that this protocol is safe for addressing behavioral issues?

Research has shown that Functional Communication Training (FCT) and its variations, such as Mult FCT and Mult FCT with Stimulus Fading, are generally safe. Studies have found that FCT effectively reduces problem behavior by teaching new communication methods, helping individuals express themselves better instead of acting out.

Various studies have successfully used FCT to treat severe destructive behavior with few safety concerns. Techniques like different schedules and gradually reducing prompts have been explored to enhance FCT's effectiveness. These methods have shown promising results without significant negative effects.

Overall, FCT and its variations are well-tolerated, making them a safe choice for addressing behavioral issues. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the trial for Refined Functional Communication Training (FCT) because it explores unique techniques that may improve outcomes for individuals with behavioral issues. Unlike standard treatments that typically rely on traditional FCT alone, this trial examines the effects of combining traditional FCT with multiple schedules and stimulus fading. This approach aims to more effectively address challenges like renewal, super-resurgence, and reinstatement of unwanted behaviors by gradually reducing the prominence of contextual cues. By exploring these innovative techniques, the trial has the potential to enhance the effectiveness and durability of behavior interventions.

What evidence suggests that this trial's treatments could be effective for behavioral issues?

Research has shown that Functional Communication Training (FCT) effectively addresses serious behavior issues. In this trial, participants will receive either traditional FCT (trad FCT) or FCT with multiple schedules (mult FCT), with some also experiencing stimulus fading. Studies have found that different schedules in FCT can quickly reduce problem behaviors in various situations. Specifically, past participants demonstrated significant improvements when FCT was used consistently and with clear guidelines. Gradually reducing support, known as stimulus fading, helps maintain these positive changes even if the situation changes or the treatment plan isn't followed perfectly. This method aims to prevent setbacks, ensuring long-term improvements in behavior. ^{1 6 7 8 9}

Who Is on the Research Team?

Wayne W Fisher, PhD

Principal Investigator

Rutgers, The State University of New Jersey

Are You a Good Fit for This Trial?

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 for a Trial Participant

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

What Are the Treatments Tested in This Trial?

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.

How Is the Trial Designed?

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+

Published Research Related to This Trial

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]

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) 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]

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]

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]

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]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC2846575/

Functional Communication Training: A Review and ... Functional communication training (FCT) is one of the most common and effective interventions for severe behavior problems. Since the initial description of ...

2. onlinelibrary.wiley.com onlinelibrary.wiley.com/doi/full/10.1002/jaba.2915

Teaching trainees to implement functional communication ... We evaluated the effects of behavioral skills training on improving participant implementation of functional communication training with multiple schedules.

3. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC4861165/

Using Multiple Schedules During Functional ... Results replicated those of the previous participants and showed rapid reductions in problem behavior when multiple schedules were implemented across settings.

4. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0023969016301023

An individualized method for establishing and thinning ... Functional communication training (FCT; Carr & Durand, 1985) is one of the most well-validated interventions for challenging behavior exhibited by individuals ...

5. aquila.usm.edu aquila.usm.edu/cgi/viewcontent.cgi?article=2458&context=dissertations

The Effects of Training Multiple Mands Within Functional ... The purpose of the current study is to evaluate the effects of training multiple mands on the resurgence of problem behavior after implementing FCT in a school ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12016749/

Teaching trainees to implement functional communication ... Functional communication training with multiple schedules (mult FCT) is one effective treatment for severe destructive behavior (Greer et al., 2016) that staff ...

7. files.eric.ed.gov files.eric.ed.gov/fulltext/ED595334.pdf

Functional Communication Training (FCT) EBP Brief Packet A FBA can be used when the intensity, duration, of type of interfering behavior creates safety concerns or impacts a child's development. Determine the ...

8. researchgate.net researchgate.net/publication/281930448_Using_Multiple_Schedules_During_Functional_Communication_Training_to_Promote_Rapid_Transfer_of_Treatment_Effects

(PDF) Using Multiple Schedules During Functional ... Many studies have shown that (a) functional communication training (FCT) is effective for reducing problem behavior, and (b) multiple schedules ...

9. practicalfunctionalassessment.com practicalfunctionalassessment.com/wp-content/uploads/2021/09/jessel-et-al-2021.pdf

On the Occurrence of Dangerous Problem Behavior during ... Our results suggest that the functional analyses with the open- contingency class reduced the likelihood of observing dangerous problem behavior. Keywords.