Autism Kit for First Responders
by Sarah Hansen
At the Hussman Institute for Autism, we “make communication the centerpiece” of all our activities. Helping an individual with autism develop the ability to communicate his needs and engage in social communication is one of the most powerful ways to improve his quality of life. It gives an individual greater control over her environment and facilitates her interaction with others. As an added benefit, teaching an individual these communication skills also often reduces the frequency of his challenging behaviors, which makes life easier for everyone.
Research has repeatedly demonstrated that a technique called “functional communication training” (FCT) can effectively reduce challenging behaviors and increase spontaneous communication, either verbally or with alternative or augmentative communication (AAC) devices. Even better, this training translates smoothly from formal intervention sessions with a trained therapist to informal, unplanned interactions in school or the community.
Researchers V. Mark Durand and Edward G. Carr pioneered FCT in 1985 and further developed it in the 1990s during their tenures in the psychology departments at the University at Albany and Stony Brook University, respectively. Since then, their methods of positive behavior support have been widely adopted—including into the federal Individuals with Disabilities Education Act (IDEA).
The goal of FCT is to identify the underlying needs that are served by a behavior, and then teach individuals to use words, signs, picture cards or other forms of communication, rather than challenging behaviors, as a more efficient way to meet those needs. Rather than simply seeking to reduce problematic behavior, this method respects the individual and her needs.
A study by Carr and Durand in 1991 confirmed the efficacy of FCT in a group of three children. First, the researchers determined the unmet need that was at the root of challenging behaviors by asking the children’s teachers to complete the Motivational Assessment Scale (MAS) for each student. Among the most frequent needs underlying behaviors are 1) to escape or take a break from an undesirable activity or environment; 2) to obtain access to tangible items such as food, toys or other objects; 3) to obtain social attention, even if that attention is in the form of reprimands; and 4) to obtain sensory reinforcement, which may sometimes be automatically provided by the behavior itself. Another need that often drives behavior, but is not covered by the MAS, is to communicate physical discomfort or sickness.
After the need underlying the behavior was identified, the children were taught a more efficient communicative alternative to meet that need. For example, the children were taught to say phrases such as “Help me,” “I don’t understand,” or “Am I doing good work?” to obtain assistance or receive social attention, depending on their MAS results. To ensure that communication was more efficient, initially trainers gave the children frequent prompts to use and receive reinforcement for new communication skills (as often as once per minute), while ignoring challenging behaviors unless they were dangerous, in order to “extinguish” the reinforcement of those behaviors.
As challenging behaviors decreased, trainers gradually faded the frequency and extent of prompting, until the children were using their new skills spontaneously. Importantly, children maintained their communication skills as they passed through multiple grade levels to new teachers, classrooms, and classmates.
The following year, Durand and Carr published another study with a larger group of students (12) that focused on attention-seeking behaviors. Children who demonstrated such behaviors were split into two groups: one received a similar fading-support FCT process to the 1991 study and the other received “time-out” training to reduce problem behaviors. Both methods significantly reduced challenging behaviors when the environment was consistent, but only children who experienced FCT maintained reduced problem behaviors when interacting with individuals unaware of the training the child had received.
A 1999 study by Durand and Carr further investigated the use of FCT with minimally verbal individuals who use augmentative and alternative communication methods (AAC). They found that the FCT was effective for these children as well. Speech-generating AAC devices were more effective than visual AAC, such as picture boards. This was especially true in the community, where background noise is often high. In this study, they were also able to teach the children to repeat a comment/request using their AAC, rather than immediately reverting to a challenging behavior when the intended recipient of their communication did not respond on the first attempt.
These studies confirm that challenging behavior has a function—it’s typically not just a tantrum, and it doesn’t simply come “out of the blue.” By making the effort to understand that function, rather than only trying to stop the behavior, everyone benefits.
These studies also show that communication skills taught in a formal intervention setting can translate into novel environments. That’s essential, because life doesn’t happen in a quiet room with a trained therapist. Teaching children communication skills that promote their well-being and that any decent person would respond to appropriately (like a request for help), is better than simply controlling behavior with a procedure that only people who know the child’s background are likely to employ (like time-out). It empowers children to get their needs met in any environment, and reduces challenging behaviors.
A 2015 publication reviews FCT’s first successful trial in 1985 and acknowledges dozens of others over the last 30 years. Among the central goals of the Hussman Institute is to help to increase the use of these and similar practices, which presume competence and maintain the dignity of people with autism, in homes, classrooms, and communities.
The original studies are published here:
Durand, VM & Carr, EG. 1991. Functional communication training to reduce challenging behavior – maintenance and application in new settings. Journal of Applied Behavior Analysis. 24(2):251-264.
Durand, VM & Carr, EG. 1992. An analysis of maintenance following functional communication training. Journal of Applied Behavior Analysis. 25:777-794.
Durand, VM & Moskowitz, L. 2015. Functional communication training: Thirty years of treating challenging behavior. Topics in Early Childhood Special Education. 35(2):116-126.
Durand, VM. 1999. Functional communication training using assistive devices: recruiting natural communities of reinforcement. Journal of Applied Behavior Analysis. 32(3):247-267.
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