Best Practice for Understanding Why Problem Behaviour Happens
The occurrence of problem behaviour is one of the most common concerns expressed by parents, therapists, educators and clinicians.
Behaviours of greatest concern include self-injury, aggression, and self-stimulatory behaviour. Traditionally treatment decisions are based on what the behaviour looks like; if the behaviour is aggression, use treatment X, but if it is self-injury, use treatment Y. For example, if a child aggresses toward another child in school, they are often issued a detention or suspension. However, if they bite themselves, they are restrained. While these interventions seem plausible, the unfortunate truth is that treatment that focuses on what the behaviour looks like is often ineffective, insufficient, or needlessly restrictive.
For over two decades, scientists and clinicians have contributed to an ever growing body of research that strongly supports the use of assessment tools prior to the development of treatment plans for significant problem behaviour. This research indicates that when the reason for the behaviour can be determined before the intervention is developed, treatment is more effective and efficient. Currently, functional behaviour assessment, a systematic and precise analysis of problem behaviour, its context, and its consequences, is the only empirically validated tool. In fact, it is the only assessment measure prescribed by U.S. federal legislation for the assessment of severe problem behaviour.
A functional behaviour assessment occurs in three distinct steps. The assessment process starts with a structured interview. This gives primary caregivers an opportunity to talk about the behaviour including its severity, frequency and intensity. The Functional Analysis Screening Tool (FAST), the Motivation Assessment Scale (MAS), and Questions about Behavioural Function (QABF) scale are all commonly used questionnaires. While interviews provide useful information, they do not replace the remaining two steps of a functional behaviour assessment (Paclawskyj et al., 2001). Unfortunately, many well meaning practitioners stop the assessment process at this stage under the false assumption that they have sufficient information. The result is often an incomplete or ineffective intervention plan.
The second step in a functional behaviour assessment is systematic, direct observation of the problem behaviour. The goal is to identify what happens both before and after the problem behaviour occurs. This is often referred to as the ABCs:
- Antecedent – what happens in the environment before the behaviour occurs
- Behaviour – the behaviour that we see exhibited by the child
- Consequence – what happens in the environment after the behaviour occurs
Observations of the behaviour occur across a variety of environments and occasions. Once the data are collected, it is analysed for trends in antecedents and consequences in order to form a hypothesis about what causes the behaviour.
The third and final step in a functional behaviour assessment is a functional analysis. In this step the clinician systematically alters the specific antecedents and consequences identified in step 2 in order to test the hypothesised cause. This process is complex and requires specialized training to conduct. A detailed description of the specific procedures is outlined by Iwata, Dorsey, Slifer, Bauman, and Richman (1982/1994). While there is a large body of research to support the necessity of this final step in the assessment of significant problem behaviour (e.g., Lerman & Iwata, 1993; Pence, Roscoe, Bourrett, & Ahearn, 2009; Thompson & Iwata, 2007), most clinicians tend to skip it or avoid it due to lack of sufficient training, preparation, or funding.
For the purpose of understanding what a functional behaviour assessment offers; let’s look at a specific example of a young child who engages in loud and persistent screaming at both home and school. If the behaviour is treated based solely on how it looks, the teacher or parent would likely use time-out as it reduces the noise level and provides a specific consequence for the behaviour. However, if the child screams to get out of doing work or completing homework, time-out would likely reinforce screaming by delaying the completion of the task. The time-out procedure would actually be counter therapeutic.
If a clinician conducts an interview, intervention would be based only on the perspective of the parents. The parents might report that the behaviour happens when the child is told to put on his shoes. Given this information and no direct observation, the clinician might hypothesize that there is a sensory issue related to wearing shoes. The child would be given a new pair of shoes meant to reduce the “sensory input” from his existing pair. If the screaming continues, the hypothesis would be incorrect indicating that the behaviour is happening for a reason not related to sensory input. Screaming could be due to a need for attention, escape or access to preferred items, but unfortunately an interview would not provide sufficient details. If no further assessments are conducted, the clinician is likely to continue to use trial and error.
If the clinician adds direct observation to the assessment, they may find other situations in which screaming occurs. For example, they may observe screaming when it’s time to go outside and when the child wants chocolate instead of dinner. The clinician might determine that the behaviour happens in an attempt to get preferred things so they teach the child to ask for chocolate and to go outside, but the screaming still continues. Again, the hypothesis is incorrect. The cause is not a desire to get preferred things, but instead might be to communicate that they want to escape dinner. Again, the clinician is left to use trial and error to determine the best intervention. This process can be time consuming and expensive.
It is only when part 3, the functional analysis, is conducted that the clinician can truly test the hypotheses generated from the interview and direction observation. This means that the clinician systematically evaluates if the screaming happens to communicate a sensory need, the desire for preferred items or the need to escape or avoid non-preferred situations. The results of the complete assessment allow the clinician to conclusively determine the cause of the behaviour and therefore develop treatment that will be optimally effective (Starin, 2007).
In summary, a functional behaviour assessment consists of three steps including a structured interview, direct observation, and the systematic evaluation of hypothesized causes. Functional behaviour assessment is the only empirically validated method for identifying the cause of problem behaviour (Pence et al., 2009). Once the function is accurately determined, effective, function-based interventions can be developed. Failure to base interventions on the specific cause (function) often results in ineffective, insufficient, time consuming and/or unnecessarily restrictive procedures.
Iwata, B. A., Dorsey, M. F., Slifer, K. J., Bauman, K. E., & Richman, G. S. (1994). Toward a functional analysis of self-injury. Journal of Applied Behaviour Analysis, 27, 197-209. (Reprinted from Analysis and Intervention in Developmental Disabilities, 2, 3-20, 1982)
Lerman, D. C., & Iwata, B. A. (1993). Descriptive and experimental analysis of variables maintaining self-injurious behaviour. Journal of Applied Behaviour Analysis, 26, 293-319.
Paclawskyj, T. R., Matson, J. L., Rush, K. S., Smalls, Y., Vollmer, T. R. (2001). Assessment of the convergent validity of the questions about behavioural function scale with analogue functional analysis and the motivation assessment scale. Journal of Intellectual Disability Research, 45, 484-494.
Pence, S. T., Roscoe, E. M., Bourret, J. C., & Ahearn, W. H. (2009). Relative contributions of three descriptive methods: implications for behavioural assessment. Journal of Applied Behaviour Analysis, 42, 425-446.
Starin, S. (2007). Functional behaviour assessments: what, why, when, where, and who. Wrightslaw. Retrieved January 25, 2011, from www.wrightslw.com/info.
Thompson, R. H., & Iwata, B. A. (2007). A comparison of outcomes from descriptive and functional analyses of problem behaviour. Journal of Applied Behaviour Analysis, 40, 333-338.