COMMUNICATION IMPACT ON AGGRESSION 1

Functional Communication Training: The Impact of Mand Training on Problem Behavior in Children
with Autism

Michele L. Gagliardi

University of West Florida

Functional Communication Training: The Impact of Mand Training on Problem Behavior in Children

with Autism

“Many children with autism spectrum disorder (ASD) display challenging behaviors, including

aggression and oppositionality, which can result in a multitude of negative outcomes, such as physical

injury, significant interference with daily activities, and impaired quality of life for the child and their

family members” (Maddox, Cleary, Kuschner, Miller, Armour, Guy, Schultz & Yerys, 2018). Functional

communication training (FCT) is a frequently used, commonly proposed intervention that includes

teaching a functionally equivalent communicative response to substitute problem behavior (Gerow,

Davis, Radhakrishnan, Gregori, & Rivera, 2018). Fisher, Piazza, Cataldo, Harrell, Jefferson, and Conner

(1993) stated that functional communication training includes pinpointing the function of a problem

behavior, followed by teaching a suitable communication response to replace the problem behavior. For

the purposes of this study, problem behavior includes being physically aggressive towards others and

engaging in self-injurious behaviors (e.g., hitting, kicking, biting, scratching, or pinching self or others).

According to Tsami and Lerman (2020), treatment with FCT includes therapists identifying the

reinforcer maintaining problem behavior (e.g., attention, access to an item, escape from demands, etc.).

In order to do that, a functional analysis is required. Torres-Viso, Strohmeier and Zarcone (2018) stated

that functional analyses are frequently used to evaluate controlling variables for behavioral

topographies. Once a functional analysis has been completed, therapists can use the reinforcer that has

been maintaining the problem behavior to shape and maintain communication responses. During that

process, the reinforcer must be withheld when problem behavior is occurring.

Torres-Viso, Strohmeier and Zarcone (2018) completed a functional analysis between problem

behavior and mands. They used functional communication training, specifically in the forms of mands to

promote communication and decrease problem behavior. Torres-Viso, Strohmeier and Zarcone (2018)
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used a reversal design to conduct their study. During their experiment, they promoted communication

and used extinction to decrease destructive behavior. Their results suggested that the problem behavior

was reduced by FCT and extinction and communication was increased.

Tsami and Lerman (2019) assessed whether treatment of maladaptive behavior during

functional communication training under combined conditions, was fruitful. During the study, all

children that participated received functional communication training. After functional communication

training was established, the children were introduced to “isolated antecedents and consequences.”

Tsami and Lerman (2019) used a multiple baseline design across participants in their study. Their results

indicated that the combined condition during functional communication training resulted in higher

mands and lower maladaptive behavior from the participants.

Fuhrman, Fisher, and Greer (2016) evaluated the revival of destructive behavior after functional

communication training. They did this by using a multiple schedule of reinforcement prior to the

removal of functional communication training. Fuhrman, Fisher, and Greer used a modified ABAB

reversal design which consisted of baseline, mult FCT and extinction challenge with the discriminative

stimulus present for part A and baseline, traditional FCT and extinction challenge with no discriminative

stimulus present for part B. The authors found when an extinction challenge followed both, traditional

FCT and mult FCT, lower levels of resurgence of destructive behavior occurred. Fuhrman, Fisher, and

Greer suggest that functional communication training does increase communication and reduce

destructive behavior. They also suggest that the combination of schedule thinning and the presentation

of the discriminative stimulus throughout extinction reduced the reappearance of destructive behavior.

The authors suggest evaluating the effects of multiple functional communication training under an

assortment of conditions that normally increase destructive behavior.

Eluri, Andrade, Trevino, and Mahmoud (2016) reviewed experiments created by Bowman in

1997 and O’Conner in 2003 which assessed the treatment of destructive behavior that is maintained by

mand compliance. The authors suggested that continuous adult compliance with a child’s demands are

not always possible. The current study was designed to replicate and extend the research on behavior

that is maintained by mand compliance by incorporating a token system with response cost. Eluri,

Andrade, Trevino, and Mahmoud used a multielement design during the functional analysis and a

reversal (ABAB) design to evaluate a token system with the response cost. First the authors conducted

play sessions to see how their client would react. They used a card and a verbal statement to help the

client understand the difference between the play condition and the mand condition. Therapists then

used the reversal design to assess the token system with a response-cost. The results indicated that a

token system can successfully reduce destructive behavior if the child is taught to accept adult-directed

activities. In the discussion, Eluri, Andrade, Trevino, and Mahmoud state that the data from the mand-

compliance condition in the functional analysis were used in the baseline. They also state that further

research of play conditions should be included in the future.

Fuhrman, Greer, Zangrillo and Fisher (2018) assessed competing activities to improve functional

communication training during reinforcement schedule thinning. Two children were taught socially

appropriate responses during this experiment. The current study compared the effectiveness of

providing several competing activities to two children whose maladaptive behavior was previously

resistant to thinning of multiple schedules of reinforcement during functional communication training.

Fuhrman, Greer, Zangrillo and Fisher used alternated experimental conditions in a reversal design with a

multielement design. To begin their study, the therapists took data on each child to figure out their

destructive behaviors and their functional communication responses. Then the therapists implemented

reinforcement schedule thinning, followed by mult FCT with competing activities. For both participants,

the addition of the competing activity during functional communication training effectively reduced
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their maladaptive behavior and increased communication. Fuhrman, Greer, Zangrillo and Fisher

suggested choosing competing activities based off of the individuals within the study rather than picking

the same competing activities for both participants.

Lambert, Bloom, Samaha and Dayton (2017) reviewed the difference between serial functional

communication training, traditional functional communication training and serial DRA and how they

both impact problem behavior. The purpose of the experiment was to replicate procedures outlined by

Lambert et al. regarding problem behavior intervention to determine whether serial FCT would impact

problem behavior just as serial DRA did in Lambert’s previous study which was done in 2015. Lambert,

Bloom, Samaha and Dayton used a two-component multiple-schedule design in their experiment. The

authors began by finding out what mands were in their participants’ repertoire. Once that was

established, they began to place problem behavior on extinction and reinforce mands on an FR1

schedule. Different mands were taught throughout the process. Overall, the study increased their total

amount of communication and decreased the challenging behavior however, according to Lambert,

Bloom, Samaha and Dayton, serial FCT failed to produce both outcomes for either subject. The authors

believe that serial functional communication needs modification before it can show consistent results as

traditional FCT does.

Gerow, Davis, Radhakrishnan, Gregori, and Rivera (2018) reviewed how functional

communication training is often used as an intervention to reduce challenging behavior. The purpose of

their review was to evaluate the strength of the evidence that indicates that FCT does in fact reduce

challenging behavior. The authors of this article did not do an experiment; however, they did a three-

step process review. The independent variable they were looking at is functional communication

training and the dependent variable was the frequency of challenging behavior. Gerow, Davis,

Radhakrishnan, Gregori, and Rivera began with a systematic search, then a design quality evaluation
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followed by a visual analysis evaluation and a synthesis of descriptive information. According to the

authors, 135 experiments exhibited strong or moderate evidence for the use of functional

communication training to reduce challenging behavior. A limitation in this article was that the authors

only recorded descriptive information for participants that functional communication training was found

to be successful. Gerow, Davis, Radhakrishnan, Gregori, and Rivera indicate that future experiments

with functional communication training and reduction of challenging behavior should include more

detailed demographic information for each participant.

Throughout the research above, there was a lack of statements (in the form of mands) taught to

each participant during functional communication training. In some studies, only one mand was taught

to a child. For example, “I want help.” In the study I have conducted, the child was taught to mand using

three key phrases. The first was, “I want…,” the second mand taught was, “attention,” and the third

mand taught was, “open this.” For the first mand, the blank was left for the participant to indicate the

item wanted with the item’s name and picture. For the first phrase to be useful, the participant’s tacting

vocabulary and receptive identification was taken into consideration.

The purpose of this study was to examine Functional Communication Training in the form of

mands impact on problem behavior in children with autism. I first conducted a functional analysis to

pinpoint the function of the problem behavior. Then I used Functional communication training to teach

the child to mand for items using a program called, Proloquo2go. Access to the preferred items or

attention were given when problem behavior did not occur.

Method

Participant and Setting

The participant was a 3-year-old female diagnosed with Autism Spectrum Disorder. Her parents

were seeking treatment due to significant problem behavior. The participant was non-verbal and had
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not received any prior communication training. Her parents reported that she was able to pull them or

other caregivers towards items she desired, however if the correct item was not presented, she

exhibited physical aggression, tantrums, and flopping. Her parents also indicate that she engaged in

those problem behaviors multiple times per day. I chose the participant because she needed a way to

communicate effectively with others around her. She had the capability to used her “words” via

Proloquo2Go, she just needed the training to understand how to use those “words”. The participant also

had a wide variety of maladaptive behaviors due to her lack of understanding how to communicate for

items or people she wanted. All sessions were conducted in therapy rooms (8 ft by 10 ft) that had a table

and two chairs as well as plain carpet. The rooms were also equipped with audio and visual equipment.

Items needed during the sessions were brought in prior to her entry into the therapy room. During the

treatment phase, an iPad with a red durable case and screen protector was brought into the room. The

iPad had a program called Proloquo2Go on it. Proloquo2go is an Augmentative and Alternative

Communication (AAC) app for day-to-day communication for people who are unable to speak

(Proloquo2Go – AAC App with Symbols – AssistiveWare, 2019). Proloquo2Go was used during mand

training and treatment as the intervention (FCT).

Procedural Fidelity

Procedural fidelity “refers to the accuracy with which the intervention or treatment is

implemented” (Mayer, Sulzer-Azaroff, & Wallace, 2014). To ensure fidelity during the experiment, the

therapists were trained at the same time on the procedures of functional communication training,

mands and how to identify the behaviors being recorded. Training was also taught on how to record

data and how to adequately count frequency. Each observer was provided the same copy of operational

definitions as well as the same datasheet to record the frequency of each behavior. All sessions were

videotaped (with parent permission) to ensure data was taken correctly.

Response Measurement and Interobserver Agreement

All sessions lasted 10 minutes. Three to five sessions were conducted per day, 2 days a week for

approximately 2 months. Self-injurious behavior was defined as hitting her head, sides or back with her

hands flat or with a fist. Physical aggression was defined as any instance of or attempt to hit, kick, pinch,

bite or pull hair of other children or adults. Temper tantrums were defined as yelling or loud crying (with

or without tears) for longer than five seconds. Flopping was defined as dropping her body/body weight

to the floor or becoming limp.

Interobserver agreement data was collected during 51% of all sessions by using the Total Count

method. To do that, the smaller number divided by the larger number then multiplied it by 100 to get a

percentage. Total agreement was 92% for physical aggression, 91% for temper tantrums and 93% for

flopping.

Experimental Design

An ABAB reversal design was used to evaluate the success of functional communication training

in the form of mands as a treatment for reducing problem behavior. According to Ferron (2005), a

reversal design is when the participant is observed repeatedly prior to treatment to determine a

baseline level of behavior. The treatment is then used with the participant for several observations to

gauge whether the behavior improves during treatment. Treatment is then withheld one more time, and

repeated observations are made to see if the behavior reverses toward baseline levels. Then the final

intervention or treatment phase occurs. During the experiment, functional communication with an

emphasis in manding while using the program Proloquo2go will be the treatment. This method was

chosen because it is clearly designed to show behavior during both baselines (A) without the

intervention and the behavior during both interventions (B). When the behavior was recorded on a

graph, the experimenter was able to see how behavior changed at each point within the experiment
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which also helped the experimenter understand if functional communication in the form of a mand

decreased problem behavior.

Procedures

Functional Analysis

A multielement functional analysis (FA) was performed (e.g., Iwata et. al, 1982/1994) to

evaluate the role of positive reinforcement in the form of access to an individual’s attention and access

to a preferred item during play conditions. During the some of the play sessions, if the therapist was

playing with an item and the participant wanted access to the therapist’s attention or access to the item,

the participant would exhibit problem behavior. Based on observations, she was unable to communicate

what she desired.

Baseline Data Collection

During baseline data collection, the author provided toys for the participant to play with. The

participant did not have any functional communication training at that time but did have access to the

iPad with the program pulled up. She did not touch the iPad at any time during baseline data collection,

nor was she prompted. The author gave up any toys the child wanted access to and when the child

wanted access to the author’s attention, it was given immediately.

Pretreatment Training

After the functional analysis was performed and baseline data was taken, the participant went

through mand training on Proloquo2Go with the iPad that was provided. The program had a blank

screen with only three available buttons for the participant to choose from. Button one had the phrase,

“I want…”. Button two had, “attention” and Button three had, “open this.” When the participant clicked

on a button, it would bring up two options for each. Under the “I want…” button, two pictures of
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individual toys were brought up. She would click on whichever toy she wanted to gain access to the

item. Under the “attention” button, a picture of tickles and a hug would show up. Whenever she would

click on one of those two items, she would gain access to therapist’s attention in the form of tickles or a

hug. Under the “open this” button, a picture of bubbles would come up with arrows pointing to the top

and a picture of her juice cup would come up with arrows pointing at the lid. When the participant

would click on one of those buttons, she would gain access to the item she desired. Once she was able

to successfully use her Proloquo (4/5 trials), the treatment phase began.

Treatment

The therapist brought the items specified on her Proloquo (the two toys pictured, bubbles and

her juice cup). When the participant was denied access or misunderstood, problem behavior was

immediate. When the participant did not exhibit physical aggression, a temper tantrum or flopping and

manded for access to an item or for attention, reinforcement was immediately (within 3 seconds) given.

If there was problem behavior while the participant manded, planned ignoring was used. No prompting

was used for the functional communication response. Once the first treatment phase was done, the

second baseline phase began followed by the final treatment phase.

References

Eluri, Andrade, Trevino and Mahmoud (2016). Assessment and treatment of problem behavior

maintained by mand compliance. Journal of Applied Behavior Analysis, 49, 383-387.

Ferron, J. (2005). Reversal Design. In Encyclopedia of Statistics in Behavioral Science (eds B.S. Everitt and

D.C. Howell). doi:10.1002/0470013192.bsa567

Fisher, Piazza, Cataldo, Harrell, Jefferson, and Conner (1993). Functional communication training with

and without extinction and punishment. Journal of Applied Behavior Analysis, 26, 23-36.

Fuhrman, Fisher, and Greer (2016). A preliminary investigation on improving functional communication

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49, 884-899.

Fuhrman, Greer, Zangrillo and Fisher (2018). Evaluating competing activities to enhance functional

communication training during reinforcement schedule thinning. Journal of Applied Behavior

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Gerow, S., Davis, T., Radhakrishnan, S., Gregori, E., & Rivera, G. (2018). Functional Communication

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https://doi.org/10.1177/0014402918793399

Iwata, Dorsey, Slifer, Bauman & Richman (1994). Toward a functional analysis of self-injury. Journal of

Applied Behavior Analysis, 27, 197-209. (Reprinted from Analysis and Intervention in

Developmental Disabilities, 2, 3-20, 1982). https://doi.org/10.1901/jaba.1994.27-197

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Maddox, Cleary, Kuschner, Miller, Armour, Guy, Schultz & Yerys (2018). Lagging skills contribute to

challenging behaviors in children with autism spectrum disorder without intellectual disability.

Autism: the international journal of research and practice, 22(8), 898–906.

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Mayer, G.R., Sulzer-Azaroff, B., & Wallace, M. (2014). Behavior analysis for lasting change (3rd ed.).

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Proloquo2Go - AAC app with symbols - AssistiveWare. (2019). Assistiveware.Com.

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